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

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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

“Breakthrough” – We’ve Been Doing for 5 Years

LA_knee_surgeryThere has been an explosion of radio, televsion and newspaper advertisements announcing a “breakthrough” in non-operative treatment of the knee. These centers claim that they are offering a “new, innovative treatment” for knee arthritis which is NOT available at other doctors offices.
This is obviously false advertising and the Knee Centers should be ashamed of themselves.
All they are offering is a routine treatment which we have been routinely performing at the LOS ANGELES ORTHOPAEDIC INSTITUTE for the past FIVE YEARS.
We have been injecting a high molecular weight Hyaluronan into the knee to “oil” the joint and replace the natural lubrication which is missing in patients with degenerative arthritis. We use either ORTHOVISC or SUPARTZ which are both FDA-approved, non-drug therapy made from ultra-pure hyaluronan. It restores the natural joint fluid (hyaluronan) that cushions, protects and lubricates your knee joint. With better cushioning, your knee can move and function better.
Hyaluronon injections are indicated for patients with mild, moderate and severe degenerative arthritis.
At the Los Angeles Orthopaedic Insititute we have injected thousands of knees with many repeat patients who have been able to return to most if not all of their prior activites WITHOUT SURGERY!
Please call us if you have been told that you have degenerative or osteoarthritis of the knee and have been told you may need surgery. We can determine the BEST treatment for you and, hopefully, begin a series of Hyaluronan injections and start you moving your knees as soon as possible.
Keep Moving!

Dr. Sist0

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

ACL Tears – Autografts vs. Allografts

Tears of the anterior cruciate ligament of the knee are devastating injuries and, unfortunately, are on the rise in incidence. There are many factors to explain this but the increase is primarily among female athletes.
The treatment of a torn ACL is surgical in young patients and in older athletes who do not want to stop competing and enjoying sports.
Two recent events have occurred which verifies that the surgical procedures done by the surgeons at The Los Angeles Orthopaedic Institute are the BEST to reconstruct the ACL.
Two long term studies have just verified that allografts are inferior compared to autografts to reconstruct a torn ACL. Allografts are tissue from a cadaver (dead body) and an autograft is from the patients’ own body. The advantages of an allograft are smaller incisions and less pain in the first week post-operatively. The disadvantage, however, is a higher FAILURE rate which is unacceptable.
We have always known that autografts are superior and we have ALWAYS recommended autografts to our athletes!
The choice of autografts is either the patients’ patellar tendon or the hamstrings. We have always preferred the patellar tendon for THREE main reasons.
#1 – The patellar tendon has bone on either side and we get bone to bone healing which is the quickest and strongest graft!
#2 –  The patellar tendon is the strongest graft!
#3 –  We do not want to sacrifice the hamstring tendons as this leads to knee weakness and stress on the reconstructed knee.
Adrian Peterson, the elite running back for the Minnesota Vikings just returned from ACL surgery and had his best running year ever. Of course he had a patellar tendon autograft which is what we have been performing in our patients over the past twenty years.
The Los Angeles Orthopaedic Institute surgeons are the orthopaedic surgeons for Calstate Northridge (CSUN) which are the only Level I Scholarship Athletes in all of the San Fernando, Santa Clarita and Antelope Valleys. The most elite athletes, coaches and trainers have selected us to perform these surgeries on their athletes for over 15 years!
We hope you maintain healthy knees but if you or a friend tears the ACL we should be your FIRST CHOICE!

Stay Healthy,
Dr. Sisto

How About A Partial Patellofemoral Joint Replacement?

An article title “Patellofemoral Arthroplasty in Arthritis Patients” was published in the most recent issue of Current Trends from the Department of Orthopaedic Surgery at Mayo Clinic. The authors presented their results of the minimally invasive, partial joint replacement surgery of the patellofemoral joint and they are excellent.  The Mayo Clinic is advocating patellofemoral arthroplasty for isolated arthritis of the patellofemoral joint (“knee-cap”).
I have recently submitted my ten year results of my patients who have undergone a “partial” joint replacement (arthroplasty) of the patellofemoral joint.   My results are fantastic and all of the patients are still satisfied 10 years later and none of them have had any additional surgery.  I will be presenting this paper at The American Academy of Orthopaedic Surgeons Meeting in Chicago March 2013.
Many surgeons will recommend a Total Knee Arthroplasty (replacement) to treat patients with arthritis of the knee.  This is an acceptable treatment but a full knee replacement does have increased complications, more post operative pain and requires a longer recovery time.  A PARTIAL Knee Arthroplasty utilizes a minimally invasive technique, usually a same-day discharge from the surgery center, significantly less post-operative discomfort, less complications and a quicker, more natural recovery.
At the Los Angeles Orthopaedic Institute we specialize in this minimally invasive technique and invite you to consult with us if you have significant knee pain and, especially, if another surgeon has recommended a Full Knee Replacement.  Hopefully, you will be able to undergo a partial replacement and enjoy a much easier recovery and enjoy your minimally invasive surgical experience!
Keep Moving!
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