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

Fifth Straight Year!

The 2013 Southern California SUPER DOCTORS issue of Los Angeles Magazine has just hit the newstands and I am happy and proud to announce that I have been selected.  This is the fifth straight year I have been chosen and it is particularly gratifying because we are chosen by our PEERS. This means that most of the orthopaedic surgeons in Los Angeles selected me to be on this small and prestigious list. In fact, I am the ONLY orthopaedic surgeon from the Antelope Valley on the list and one of only a few in the San Fernando and Santa Clarita Valleys as well.
I believe the main reasons I am always selected to the SUPER  DOCTOR list include the fact that I am the team physician for Cal State Northridge (CSUN) athletes. I am the ONLY orthopaedic surgeon in our three valleys that operates on elite, scholarship athletes. There are only a few Division I athletic programs in Los Angeles (UCLA, USC, CSUN, Pepperdine, Loyola Marymount) and the school officials, athletes and athletic trainers trust me to perform the surgery on these gifted athletes who MUST return to the same level of play prior to their injuries!
The second reason I am selected is that I specialize in minimally invasive, PARTIAL joint replacements which allow the patients to recover much quicker with less discomfort.
I am proud to be selected again to be one of the SUPER DOCTORS of Southern California and I look forward to taking care of you and your family when I am needed.

Keep moving!
Dr. Sisto

Minimally Invasive Rotator Cuff Repair

The rotator cuff tendons of the shoulder function to raise our arm and allows us to perform activities as exciting as throwing baseballs and shooting baskets as well as merely combing our hair without pain or discomfort. Tendons are structures which connect muscle to bone and they are like pulleys which raise and rotate our shoulders. In normal, pain free shoulders the tendons glide under the bony roof of the scapula and allow us to perform over-the-shoulder activities pain free.
The tendons, however, can tear secondary to trauma such as a fall onto the shoulder or they can tear secondary to overuse and cause pain and weakness of our shoulder.
The treatment of a rotator cuff tear is surgical and we perform minimally-invasive arthroscopic techniques to repair the rotator cuff. These mini-incisions cause MUCH LESS discomfort and the recovery following surgery is much faster and more dependable.
Please contact us if you have shoulder pain and certainly contact us if another orthopaedic surgeon has recommended a rotator cuff repair to see if you are a candidate for a minimally invasive arthroscopic rotator cuff repair.

Dr. Sisto

Top Doctor Award

I have been selected as one of the TOP DOCTORS in Los Angeles for the third straight year. This is a prestigious award as the TOP DOCTORS are voted in by their peers which is the highest source of praise>

There are a number of reasons which contributed to my selection and I believe that my specialty in minimally invasive surgery of the knee and shoulder is my most significant contribution to my peers and to my patients. I have published multiple peer-reviewed articles on PARTIAL ARTHROPLASTY (Replacement) of the knee and, in fact, will be presenting our ten-year results of partial knee arthroplasty at the Academy Meeting in San Francisco in February. Our ten-year survivorship is 100% and my implant design and techniques have been shared with all of the other orthopaedic surgeons in the country who now utilize this procedure. My peers have benefited from my research and my patients have certainly benefited as well.

Please call me if you have been told by another orthopaedic surgeon that you require a total knee arthroplasty. You may, in fact, be able to undergo a PARTIAL KNEE ARTHROPLASTY which has a much quicker recovery time and a much lower complication rate. The post-operative pain is much less and the results are superior as well.

Please contact me if you have knee pain and your life has been altered by pain and a restriction of activities. A more youthful knee is definitely in your future!

Stay Active!
Dr. Sisto

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