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

Congratulations Nasim Kalhor, DPM!

Congratulations to Dr. Nasim Kalhor of Los Angeles Orthopaedic Institute for receiving the Patient’s Choice Winner Award from OpenCare! Dr. Nasim Kalhor is a Board certified podiatric surgeon specializing in the medical and surgical treatment of the foot and ankle.

Meet Nikki!!!

One of the most exciting events which has occurred at The Los Angeles Orthopaedic Institute is our incorporation of physician assistants in our practice.  Physician assistants (PA) are trained to evaluate patients, perform procedures in the office and the emergency room, assist in surgery and make the hospital rounds to treat our surgical patients.  They are a vital link between the surgeons at LAOI and our patients and they are an indispensible part of our team.

Coury Clemens was one of our first PA’s and he has been with LAOI for nearly three years.  We have recently recruited Nikki Sisto to join our group a few months ago. She graduated from Boston University and completed a 2 1/2 year Physician Assistance program at Pace University in New York City.   She grew up in the San Fernando Valley and we were able to convince her to return home. She has been an amazing asset to our office and she has exceeded all of our expectations!!  She is an excellent assistant in the operating room but her true strengths are her breadth of medical knowledge and her compassion for the patients.  She listens to them and makes every attempt to smooth their recovery following a fracture or major recontructive surgery.

The best part is that her prescence has engergized me and has given me more enthusiasm than ever to teach and continue to deliver the best care to all our patients. Nikki, as you may have guessed, is my daughter and I could not be prouder of her or more excited to come to work each day with her. Her joining our team has been a “dream come true” for me and all of our patients will benefit from working with her as well.

All of our patients are MORE THAN EVER in the best hands at The Los Angeles Orthopaedic Institute!

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

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

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