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

Autogenous Patellar Tendon Graft for ACL’s

The autogenous patellar tendon graft is the gold standard for anterior cruciate ligament (ACL) reconstruction of the knee.  Two new studies just published in the prestigious American Journal of Sports Medicine have confirmed that the autogenous (the patient’s own) patellar tendon graft is superior to the autogenous hamstring graft. The results were quite dramatic as patients with hamstring tendon grafts had TWICE the risk of revision compared with patients with patellar tendon grafts!! Younger age was the most important risk factor for revision, and no effect was seen for sex.

We routinely recommend the autogenous patellar tendon graft in competitive athletes 40 years of age and younger. The procedure is difficult to do and that is why other orthopaedic surgeons do not perform it BUT the results are superior to any other ACL reconstructive procedure.

Please call us if you have any questions about ACL reconstruction and which procedure would be best for you!

Keep Moving!

Dr. Sisto

Congratulations Northridge Hospital


Congratulations to Northridge Hospital Medical Center for being designated a Blue Distinction Center for Knee and Hip Replacement by Anthem Blue Cross and Blue Shield of California. This national designation is given to medical facilities that have demonstrated expertise in delivering quality specialty care in comprehensive in patient knee and hip replacement services.

The reason I am excited about this award is that Blue Destination Centers have a proven track record for delivering better results including fewer complications and re-admissions than hospitals without these recognitions.

I have been on staff at Northridge Hospital for twenty five years and have performed over one thousand knee arthroplasties at this great hospital. I am proud of this distinction and invite you to discuss the advantages of having a partial or total knee arthroplasty at Northridge.

Keep Moving!
Dr. Sisto

“Breakthrough” – We’ve Been Doing for 5 Years

LA_knee_surgeryThere has been an explosion of radio, televsion and newspaper advertisements announcing a “breakthrough” in non-operative treatment of the knee. These centers claim that they are offering a “new, innovative treatment” for knee arthritis which is NOT available at other doctors offices.
This is obviously false advertising and the Knee Centers should be ashamed of themselves.
All they are offering is a routine treatment which we have been routinely performing at the LOS ANGELES ORTHOPAEDIC INSTITUTE for the past FIVE YEARS.
We have been injecting a high molecular weight Hyaluronan into the knee to “oil” the joint and replace the natural lubrication which is missing in patients with degenerative arthritis. We use either ORTHOVISC or SUPARTZ which are both FDA-approved, non-drug therapy made from ultra-pure hyaluronan. It restores the natural joint fluid (hyaluronan) that cushions, protects and lubricates your knee joint. With better cushioning, your knee can move and function better.
Hyaluronon injections are indicated for patients with mild, moderate and severe degenerative arthritis.
At the Los Angeles Orthopaedic Insititute we have injected thousands of knees with many repeat patients who have been able to return to most if not all of their prior activites WITHOUT SURGERY!
Please call us if you have been told that you have degenerative or osteoarthritis of the knee and have been told you may need surgery. We can determine the BEST treatment for you and, hopefully, begin a series of Hyaluronan injections and start you moving your knees as soon as possible.
Keep Moving!

Dr. Sist0

PRP Treatment Now Available

A number of new studies have been published discussing the role of Platelet-Rich Plasma in treating patients with degenerative arthritis of the knee. Platelets are found in our blood and are responsible for blood clotting to prevent excessive bleeding. Platelets are also sources of cytokines, which regulate healing and tissue regeneration in the body. The theory of Platelet-Rich Plasma (PRP) therapy is the hope that if a concentrated amount of our own platelets are injected into the knee that it may lead to a healing of the degenerative changes which have occurred in the knee. In essence, it is a process of healing damaged cartilage in the knee.

The surfaces of our bones are lined by a smooth, glistening surface called articular cartilage which allows the bones to glide over each other. The loss of the articular cartilage allows bone to be exposed and the bone on bone grinding causes pain, swelling and stiffness in the knee. This is called degenerative arthritis.

We have been treating a number of patients with PRP in the office with exciting success at short term follow up. The process is done in the office and starts with the patient having a small amount of blood drawn by our staff. The blood is prepared by a special process which concentrates the platelets and other growth factors into a syringe. The “super-healing” concentrate (PRP) is then injected into the knee.

Recent studies in the American Journal of Physical Medicine and Rehabilitation and The American Journal of Sports Medicine have indicated that PRP can be helpful in treating degenerative arthritis.
We are all committed at The Los Angeles Orthopaedic Institute to making our patients’ knees younger and, hopefully, avoiding surgery. Please contact us if you have knee pain and wish to discuss the new non-operative techniques which are now available.

Stay Healthy,
Dr. Sisto