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

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

Happy New Year

Wishing all of our patients a happy & healthy New Year!