Practice Makes Perfect

The lead article in the October issue of The Journal of Bone and Joint Surgery concluded that patients undergoing a total knee arthroplasty (replacement) with high volume physicians and hospital achieve better outcomes.  The Los Angeles Orthopaedic Institute including Drs. Sisto and Sobeck are very high volume total knee arthroplasty surgeons (greater than 145 per year) and we agree with the recert of this study “Practice does make perfect” and our high volume confirms this.  We strive to have the best outcomes with the lowest complication rates in Los Angeles.  Please visit us to learn more about our success at maximizing your surgical result following a knee surgery.

Keep moving!!!

Dr. Sisto

Practice Makes Perfect

The newest edition of the Journal of Bone and Joint Surgery contains an article titled “Effect of Surgical Caseload and Revision Rate Following Total and Unicompartmental Knee Replacement”. The aeticle is based on the results of 500,000 patient records from England and clearly shows that high volume surgeons attain the best results following partial knee replacements (uni) and total knee replacements.
In other words, the SINGLE most importatnt determining factor to maximize the result of the surgery is to select a knee surgeon who does the most procedures. Dr. Sobeck and myself perform more total knee arthroplasties than any other surgical group in our valleys, PERIOD.
If you have knee pain and have been told that you require a joint replacmeent surgery, the best thing you can do is get a second opinion with us at the Los Angeles Orthopaedic Institute.
We are looking forward to maximizing your result and having you return to an active, pain free life.
Keep Moving!!
Dr. Sisto

Patello-Femoral Replacement (PFR)

Do you have severe pain under or around your kneecap?
Have you been told by your doctor that you may need knee replacement surgery?
Are you interested in learning about a less-invasive partial knee replacement that is custom made just for you?

What are your options?
If you have severe pain under and around your kneecap, your doctor may first recommend conservative treatment involving rest, physical therapy and analgesics. If your pain is not manageable with these measures, you may be a candidate for surgery.

Types of surgery for arthritis around the kneecap

There are several types of surgery intended to treat severe arthritis around the kneecap. These options include soft tissue procedures (such as a lateral release), cartilage replacement, chondroplasty, microfracture, bone and tendon realignment procedures, and replacement of the painful portion of the knee (partial and total knee replacement).
 Replacement of the entire knee joint (total knee replacement) has been used to treat arthritis that is isolated to the kneecap portion of the knee. With total knee replacement, however, all portions of the knee are replaced, even if they are healthy!
Many experts believe that total knee replacement is too aggressive for someone who suffers from arthritis in just one portion of the knee. These experts believe that your knee will function better if you are able to keep the healthy portions in your knee and only replace the area that is damaged. Another consideration is that total knee replacement requires removal of bone from your entire knee and, if the implant does not last you for the rest of your life, the challenges of subsequent repair are increased because there is simply less bone to work with for implantation of the revision knee components.

Read more about PRF at the Los Angeles Orthopaedic Institute…

The Elephant in the Room

Total knee arthroplasty also known as a knee replacement has been an amazing break through procedure. We are able to perform this operation when the smooth articular cartilage is worn off the bones surfaces and the bones are grinding on one another causing pain and stiffness.  The knee arthroplasty replaces the smooth surfaces of the knee and patients are able to function without pain and enjoying a much more active lifestyle.  All surgeries, no matter how successful, do have risks of complications and one, but major, complication of a knee arthroplasty is infection.  Infection is the elephant in the room that no one likes to talk about but it happens in approximately 0.5% of knee replacements.  This is only one out of two hundred but it is devastating and we need to bring the number to zero if we can.

The joint replacement team at The Los Angeles Orthopaedic Institute strives to avoid infection at all costs.  We have our patients take pre-operative cleanses with Chlorhexidine Gluconate (Hibiclens) prior to the surgery to clean the skin.

We also have the patients clean the nostrils with Mupirocin (Bactroban) which sterilzes the nasal passages.  The nostrils have been recognized to harbor staphylococcus which is the primary bacteria that cause knee infections.

In addition, all of our patients receive intra-operative antibiotics and our surgeons are among the fastest to perform the surgery in Los Angeles as it has been recognized that the infection rate goes down if the surgery is performed quickly.  We do more knee replacements than any other group in the valley and our times are the quickest as well.

We are proud of the fact we have one of the lowest infection rates in Los Angeles and we strive every day to get our infections to ZERO.

We look forward to seeing you in the future to discuss our ZERO infection campaign and we look forward to caring for you and your friends and families.

Keep moving!

Dr. Sisto

Minimizing Blood Loss in Total Knee Arthroplasty

A total knee arthroplasty (total knee replacement) is one of the most successful surgical procedures that can be performed and has allowed countless patients to be more active and pain free. Recent advances have allowed surgeons to perform the surgery through small, minimally invasive incisions and pain managerment protocols are utilized to minimize discomfort transforming a total knee arthroplasty into a much more pleasant experience.
Blood loss has previously been a concern and a blood transfusion had historically been expected in the post-operative period. Blood transfusions are safer today but there is still a risk of hepatitis and allergic responses which can be debilitating.
I was the first knee surgeon in the San Fernando Valley to utilize Tranexamic Acid to minimize bleeding during the surgery and eliminate the need of a blood tranfusion.
Tranexamic acid is a clot stabilizer and decreases blood loss in surgical patients. There is no increased risk of thrombophlebitis or pulmonary embolus.
I have successfully used Tranexamic acid for the past two years and NONE of my patients have required a blood transfusion.
Our patients expect this type of innovative care from myself and my colleagues at The Los Angeles Orthopaedic Institute.
We look forward to always being on the cutting edge of innovation of knee and shoulder surgery and which will maximize the outcomes for all of our patients.

Keep Moving!
Dr. Sisto

George W. Bush has a Partial

This past Memorial Day weekend our former president, George W. Bush underwent a partial knee replacement surgery in Chicago, Illinois. The knee has three compartments consisting of the medial (inside), lateral (outside) and the patello-femoral (front) compartments. The surfaces of our bone in all 3 compartments are lined by smooth, glistening articular cartilage which allows the bones to glide on each other. When this smooth articular cartilage is lost, the bones grind on one another and cause pain. The best analogy is when a tire tread wears down on a car and the rim is grinding on the road. That sounds painful as well!!!

A full knee replacement is when ALL 3 compartments are resurfaced with a metallic cap on the thigh bone (femur) and plastic caps on the tibia bone (shin) and patella (knee cap). This is a great operation when ALL 3 compartments are involved BUT frequently only one compartment has arthritis (loss of articular cartilage) and a MUCH smaller partial knee arthroplasty (replacement) can be done. The advantages of a partial knee arthroplasty is a shorter hospital stay, less discomfort, significantly less complication rate and a much quicker recovery. This is why George W. had a partial knee replacement and why he will be clearing brush on his Texas ranch soon.

Fortunately, residents of California do not have to travel to the windy city to have the best partial knee replacement surgery. Dr. Domenick Sisto, trained at the Hospital for Special Surgery in NYC, is located in Sherman Oaks and in Palmdale, California. Dr. Sisto has published many peer-reviewed scientific articles on the advantages of a partial knee replacement and he has performed more patello-femoral replacements than anyone else in the entire state of California.

If you have knee pain and have been told you need a Total Knee Replacement, do like George W. Bush and get on your horse and go to the experts to have your partial knee replacement performed. We at the Los Angeles Orthopaedic Institute will get you back on your feet in no time flat, partner.

Keep Moving!

Dr. Sisto

Of Mice and Men

The big scientific news this week was the research done at Stanford and Harvard where older mice were injected with the blood of younger mice. The older mice significantly improved their mental functions and added significant amounts of muscle mass.

The airwaves have been rocking with this news as it heralds the possibility of delaying and, eventually, reversing the aging process. The Fountain of Youth may be in our not too distant future.

Of course, the study was preliminary and in mice and human trials have not been done BUT the researchers have identified the protein factor in the young blood that they believe is the active factor. It is a growth differentiation protein which stimulates stem cells to differentiate into new, fresh cells throughout the body. Stem cells are those that are pluripotential meaning that they can become many different types of cells depending on the environment they are placed in. There is exciting early work being done in the knee which may allow us to eventually replace meniscus and articular cartilage!

At the Los Angeles Orthopaedic Institute we are committed to restoring cartilage and making our patients’ knees as young as possible. We routinely perform Platelet Rich Plasma (PRP) injections, Hyalgan injections and perform mini invasive surgeries to keep the knees young and active. Please call us to discuss these exciting new treatments to keep everyone active and mobile!

After all, if mice can do it so can we!

Keep Moving!

Dr. Sisto