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

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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

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

New Treatment for Degenerative Arthritis of the Knee

Exciting new developments have occurred that have expanded our ability to medically treat degenerative arthritis of the knee and, hopefully, avoid surgery.

As you all know degenerative arthritis (also known as osteoarthritis) occurs when the smooth, glistening articular cartilage on the surface of the bones wears down and the underlying bone is exposed. The best analogy is when a tire tread wears down on a car and the rim is exposed. Bone on bone contact causes pain, locking and swelling of the knee.

The new treatment is an injection of Platelet Rich Plasma into the knee. Platelet Rich Plasma (PRP) derives from our own blood which is drawn in the office. The blood is processed in the office to concentrate the platelets and growth factors to enhance cartilage repair. PRP acts to stimulate endogenous hyaluronan production which is the natural lubricate of the knee. PRP also decreases cartilage catabolism (breakdown). PRP also suppresses the inflammation of the knee.

This is an exciting new treatment option in patients with degenerative arthritis of the knee.

Please call us if you are having knee pain and we will keep your knees running!

Keep moving!

Dr. Domenick Sisto

Congratulations Northridge Hospital

Kemp.H-education

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

Everything Old is New!

Everything Old is New Again!

Cole Porter 1930
You may have seen multiple advertisements telling you that you should have a robotic-assisted total knee arthroplasty (replacement) to improve your result. These ads were paid for by hospitals that are attempting to convince you that a robot or computer assisted surgery is an improvement and will maximize your result.
The TRUTH, however, is that mulitple studies have confirmed that patients who have had computer navigation have the same results as those who have the surgeon perform the essential aspects of the surgery. All of these studies have shown that there was no difference in clinical function, alignment, and survivorship of the components between the computer-navigated and conventional or traditional total knee arthroplasties.

The hospitals that are advertising the beneficial effects of computer or robotic navigation are tricking you into paying more money travelling a greater distance to have a total knee arthroplasty when there is ABSOLUTELY NO EVIDENCE that a computer or robotic surgery is better.

The Los Angeles Orthopaedic Institute performs more total knee arthroplasties than any other group in the San Fernando, Santa Clarita and Antelope Valleys. Our surgeons have over 25 years experience in mastering the surgical techniques as well as catering to every one of your concerns to maximize your result.

Trust us to take you through this difficult journey and we will get you back to a more youthful and athletic lifestyle to allow you to enjoy our NEW knee.

If you have knee pain and have been told you may need a knee surgery, please call us to discuss the best option for you to MAXIMIZE your results.

Keep Moving!!
Dr. Sisto