Stem Cells: Are they right for you?

Biologic factors to enhance healing and treat degenerative arthritis are commonly being performed and our patients are constantly asking the doctors at Los Angeles Orthopaedic Institute if Stem Cells or Platelet Rich Plasma (PRP) are correct for them.

Platelet Rich Plasma (PRP) is performed by taking a blood sample from the patient, spinning the blood down to isolate the growth factors and injecting these cells into the injured joint. The success rate varies depending on the diagnosis and chronicity of the disease. In general, soft tissue injuries including lateral epicondylitis of the elbow (“tennis elbow”), patellar tendonitis of the knee (“jumper’s knee”), iliotibial band tendonitis of the knee (“runner’s knee) and Achilles tendonitis respond best to PRP. Degenerative arthritis of either the shoulder, knee and hip can be significantly helped but the results can vary.

Stem cells are the  New buzz word and there is evolving evidence that they play a role in the treatment of musculoskeletal disease. Adult stem cells have the most promise for use right now and there are two types that are utilized. Both of the types are taken from the patient’s own body. A third type are amniotic cells taken from a donor.

There are advantages and disadvantages of each type but the best information a patient can get is discussing the possibilities with their doctor at Los Angeles Orthopaedic Institute. All of our doctors are experts in Stem Cells and PRP and we will discuss whether these new and exciting treatment modalities will alleviate your pain and increase your mobility.

 

 

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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

What Kobe Bryant’s Surgery Means to You!

Kobe Bryant has recently undergone a rotator cuff repair which has ended his 2015 season and may jeopardize his career. The purpose of this blog is to explain the function of a rotator cuff, how it can tear and what the symptoms are and to outline the various treatment options that are possible. Each patient does not have the same physical demands and expectation of function that Kobe must have and each patient must individualize their treatment program based on their own needs and goals.
The rotator cuff is made up of four tendons that blend together and rotate the shoulder. A tendon is a structure that connects muscle to bone and is the pulley that lifts and rotates the shoulder. A tendon can tear from an acute, significant injury like a fall onto the shoulder or dunking a basketball such as Kobe or it can be a chronic, repetitive stress that tears a degenerative tendon such as merely lifting a suitcase.
The tendon is under tension like a guitar string and pulls apart and can no longer function as a shoulder rotator. The patient will complain of pain particularly on overhead activities and weakness to external rotation.
Patients of all ages who develop these symptoms should be seen by an orthopaedic surgeon as the sooner a diagnosis is made the sooner the appropriate treatment can be initiated based on the patient’s age, level of pain and weakness and their own goals and demands.
An MRI (Magnetic Resonance Image) is the diagnostic test that confirms the diagnosis. (A standard x-ray will not visualize the rotator cuff tendon) All insurance companies will pay for this procedure as it is the standard of care.
The problem with rotator cuff tears is that if untreated many progress in size and lead to more pain and more shoulder weakness and loss of function. A number of the tears, however, do not progress and current reasearch protocols are trying to determine which tears progress and which tear should definitely be treated with surgery.
In general younger patients (less than 60) should be treated with a surgical repair as a tear will progress in younger, more active patients. Older patients (greater than 70) can be treated with physical therapy to build up the surrounding muscles to compensate for the torn muscle-tendon joint. Patients between 60 and 70 need to individualize their care based on their symptoms and goals.
The GOOD NEWS is that a surgical repair of a torn rotator cuff tendon is highly successful with results greater than 90% in most studies.
I spent a year studying the surgical repair of the rotator cuff with Frank Jobe, the legendary shoulder surgeon who founded the Kerlan-Jobe Orthopaedic Clinic. The doctors here at the Los Angeles Orthopaedic Institute have performed thousands of rotator cuff repairs and would welcome the opportunity to outline an appropriate treatment for you and your rotator cuff!
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

Super Doctors!

I am proud to report that I have been selected to the Los Angeles Magazine Super Doctors List 2015 as one of the top doctors in Southern California. I am one of a select group that has been on the list ever since the magazine began to recognize the Top Doctors a number of years ago.
The reason that I take pride in this award is that the selection of the Super Doctors is determined by my peers and colleagues who have selected me as one of the best Orthopaedic Surgeons in Southern California. I treat and operate on many doctors and their families in our area and I am proud of this distinction.
I will continue to strive to be a Super Doctor and one of the top Orthopaedic Surgeons in Southern California. I look forward to treating many new patients in the future and helping to keep patients moving and enjoying a pain free life.
Keep moving!
Dr. Sisto