Joint Replacement Institute - St. Vincent Medical Center

Main Menu

Skip to main content

 

 Joint Replacement Institute - St. Vincent Medical Center

Services

Joint and musculoskeletal pain or injury can often be treated effectively with non-operative treatment such as modification of activity, physical therapy, oral medications or local injections. Sometimes the pain can become unbearable and require surgery.

At the Joint Replacement Institute, our doctors provide quality care and focus on treatment specific to your needs.

Services provided by our surgeons are organized by specific area.

If you are a new patient, please download, print, and fill out the New Patient Packet corresponding to your physician prior to your appointment.

View new patient packet for each doctor

 

Foot and Ankle Replacement

Foot and ankle injuries are usually incapacitating because of the large forces applied to these parts of the body during the activities of daily living. This is why foot or ankle pain is likely to progress if not appropriately treated.

Non-Operative Treatments

Foot pain and ankle pain can have a number of origins. Our surgeons are committed to a conservative approach to treatment and usually explore non-invasive treatment options as a first step. Non-operative treatment options include:

  • Modification of patient activity
  • Physical therapy
  • Oral medications
  • Local injection

Total Ankle Replacement

Pain in the ankle joint can be the result of cartilage wear (arthritis) of the joint between the talus (ankle bone) and the tibia (lower leg bone).

Total Ankle Replacement (TAR) is a surgical option for patients with arthritis of the ankle. This operation can relieve pain and restore motion in the ankle joint as opposed to other treatment options in which range of motion and activity levels will be limited such as arthrodesis (ankle fusion). In a TAR, both sides of the ankle joint are reshaped and implanted with specially designed components. The bearing material used is generally metal (for the talar component) and polyethylene (for the tibial component). The overall track record of TAR is still short as it has been performed essentially in the last 10 years, but looks very promising so far.

Surgeons performing Total Ankle Replacement at the Joint Replacement Institute:

Achilles Tendon Repair

Even though the Achilles tendon is the strongest tendon in the human body, its rupture is a fairly common injury in healthy, young, active individuals. Surgical repair is usually the treatment of choice because it is associated with a lower rate of re-injury and shorter recovery time compared with non-surgical treatments.

Surgical repair can be performed with a closed or an open technique. With the open technique, an incision is made to allow for better visualization and approximation of the tendon. With the closed (also called percutaneous) technique, the surgeon makes several small skin incisions through which the tendon is repaired. A short leg cast (plaster) is placed on the operated ankle after either of the procedures.

Surgeons performing Achilles Tendon Repair at the Joint Replacement Institute:

Fracture Repair

A fractured bone will typically repair itself if the broken extremities of the bone are close enough and maintained immobilized. However, a surgical intervention will often facilitate a fast and complete recovery, depending on the location of the fracture and the degree of displacement between the two (or more) broken parts of the bone.

Bone fracture repair is a surgery usually involving metal screws, pins, rods, or plates to hold the bone in place. It is also known as Open Reduction and Internal Fixation (ORIF) surgery.

Joint Replacement Institute surgeons performing Fracture Repair around the Ankle joint:

Bunion Surgery

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. This condition may become painful, with a bending of the big toe toward the other toes and skin irritation.

The goal of this surgical intervention is to relieve pain and correct as much deformity as possible. This can require more than one procedure all performed during the same surgery, including removing the enlarged portion of the bone, cutting and realigning the bone, and correcting the position of the tendons and ligaments.

Surgeons performing Bunion Surgery at the Joint Replacement Institute:


Hip Joint Replacement

The hip joint can develop arthritis over time, leading to a complete wear of the articular cartilage. When this point has been reached in the development of the disease, a total hip replacement is necessary to relieve hip pain and restore function by replacing the worn cartilage with an artificial bearing on both the pelvis and the femoral head.

Whenever the cartilage on the pelvic side is preserved (i.e. after a femoral neck fracture that cannot be repaired, for example) a hemiarthroplasty can be performed, in which the head of the femur is replaced but articulates with the native acetabular (pelvic) cartilage instead of an artificial bearing material as in a total hip replacement.

Non-Operative Treatments

Hip pain can have a number of origins. Our surgeons are committed to a conservative approach to treatment and usually explore non-invasive treatment options as a first step. Non-operative treatment options include:

  • Modification of patient activity
  • Physical therapy
  • Oral medications
  • Local injection

Total Hip Replacement

RA-THRsmallTotal Hip Replacement has been one of the most successful surgical procedures from the last century and remains the gold standard for the treatment of hips with arthritis. It starts with the insertion of a stem into the femoral medullary canal. A femoral head is mated with the neck of the stem and articulates with the acetabular component fixed to the pelvic bone.

Several bearing materials are suitable for total hip replacements and all combinations of a metal or ceramic head articulating with polyethylene, metal, or ceramic liners are possible. Your surgeon will determine which bearing couple is preferable based on multiple pre-and post-operative factors.

Surgeons performing Total Hip Replacement at the Joint Replacement Institute:

Resurfacing

Hip resurfacing differs from a conventional total hip replacement in that the femoral head and neck are not resected to allow the insertion of a stem into the femoral medullary canal, but a metal shell caps the reamed femoral head to articulate with an acetabular implant.

Hip resurfacing can be performed for various diagnoses, depending on the severity of the hip disease, and as long as the femoral head and neck provide sufficient support for the femoral component.

The bearing material of choice for full hip resurfacing is metal-on-metal, because it is currently the only material allowing to manufacture thin acetabular implants (to accommodate the large femoral head) with sufficient strength to sustain the joint reaction forces associated with an active lifestyle.

Surgeons performing Hip Resurfacing at the Joint Replacement Institute:

Hip Revision Surgery

Artificial hip replacements are extremely durable but sometimes cease to function properly during the patient’s lifetime. A revision surgery is then needed in which one or all components of the previous prosthesis will be removed and replaced.

There are advantages to having the surgeon who implanted the original prosthesis also perform the revision surgery when it is needed, because this surgeon is already familiar with component types, sizes and the patient’s specific anatomy. However if this is not possible, select a surgeon who will have access to all the needed information for a successful revision surgery.

Surgeons performing Hip Revision Surgery at the Joint Replacement Institute:

Fracture Repair

A fractured bone will typically repair itself if the broken extremities of the bone are close enough and maintained immobilized. However, a surgical intervention will often facilitate a fast and complete recovery, depending on the location of the fracture and the degree of displacement between the two (or more) broken parts of the bone.

Bone fracture repair is a surgery usually involving metal screws, pins, rods, or plates to hold the bone in place. It is also known as Open Reduction and Internal Fixation (ORIF) surgery.

Joint Replacement Institute surgeons performing Fracture Repair around the hip joint:


Knee Joint Replacement

The knee joint can develop arthritis over time, leading to a complete wear of the articular cartilage. When this point has been reached in the development of the disease, a partial or a total knee replacement is usually necessary to relieve pain and restore function by replacing the worn cartilage with an artificial bearing on both the lower extremity of the femur (the thigh bone) and the top of the tibia (the main lower leg bone).

Non-Operative Treatments

Knee pain can have a number of origins. Our surgeons are committed to a conservative approach to treatment and usually explore non-invasive treatment options as a first step. Non-operative treatment options include:

  • Modification of patient activity
  • Physical therapy
  • Oral medications
  • Local injection

Arthroscopy

Arthroscopy is a procedure which utilizes a tiny camera to look inside the knee joint. This allows the surgeon to evaluate and treat knee disorders. Arthroscopy requires only small incisions around the knee for the insertion of small instruments that are about the size of a pen or pencil. With arthroscopy, degenerated and worn menisci can be trimmed and smoothed, which reduces one source of inflammation. Additionally, the lining of the knee (the synovium), can be trimmed, and this also decreases inflammation. Patients who have knee arthroscopy go home the same day. Recovery from surgery occurs over a couple of weeks. Unfortunately, the benefit of arthroscopy decreases as the degree of arthritis increases. In advanced arthritis, arthroscopy is of little value.

Surgeons performing Knee Arthroscopy at the Joint Replacement Institute:

Fracture Repair

A fractured bone will typically repair itself if the broken extremities of the bone are close enough and maintained immobilized. However, a surgical intervention will often facilitate a fast and complete recovery, depending on the location of the fracture and the degree of displacement between the two (or more) broken parts of the bone.

Bone fracture repair is a surgery usually involving metal screws, pins, rods, or plates to hold the bone in place. It is also known as Open Reduction and Internal Fixation (ORIF) surgery.

Joint Replacement Institute surgeons performing Fracture Repair around the Knee joint:

Total Knee Replacement

Front view of knee
Front View

Total Knee Replacement employs specially designed components, or prostheses, made of metals and plastics, to replace the cartilage in your knee. The metal that is most commonly used is an alloy of cobalt, chromium and molybdenum. The plastic is ultra-high molecular weight polyethylene. These materials have been used in joint replacement for about 30 years and their behavior in the body is well-known.

In modern total knee replacement surgery, only the worn-out cartilage surfaces of the joint are replaced. The entire knee is not actually replaced. The operation is basically a “re-surfacing” (or “re-tread”) procedure. Only a small amount of bone is removed, the collateral ligaments are left intact, and the muscles and tendons are left intact. Alignment abnormalities can usually be corrected during the operation by adjusting the direction of the cuts of the bones, removing bone spurs (osteophytes), and lengthening tight ligaments. Front and side views of a knee following total knee replacement are shown below. Note that the smooth surfaces of the joint are restored. The joint space is now comprised of polyethylene. The operation only replaces the worn surfaces of the joint. The ligaments, tendons and muscles are retained.


Side view of knee
Side View

Following Total Knee Replacement, more than 90% of patients have no pain, or only slight pain, and their walking is no longer limited by their knee. Most patients can live a full and independent life.

Surgeons performing Total Knee Replacement at the Joint Replacement Institute:

Uni-Compartmental Replacement

Uni-compartmental replacement of knee
Uni-Compartmental Replacement

Surgery may be considered even when only a portion of the knee surface has worn out. Uni-compartmental Knee Replacement is the partial replacement of the knee surfaces. Using minimally invasive surgery (MIS) techniques, a partial knee replacement can be inserted through a smaller incision, with minimal disruption of the muscles and tendons around the knee. The smaller incision and less invasive surgical approach allow for patients to recover more quickly. Uni-compartmental Knee Replacement may allow better knee function for return to athletic activity. Severe arthritis and deformity cannot be corrected. Inflammatory arthritis (like rheumatoid) cannot be treated by partial replacement. After Uni-compartmental Knee Replacement surgery, arthritis can still develop in the other parts of the knee.

Surgeons performing Uni-Compartmental Knee Replacement at the Joint Replacement Institute:

Knee Revision Surgery

Although it is anticipated that a total knee replacement will last for many years, some fail sooner than expected. The main causes of failure are loosening, wear, osteolysis and component breakage. Fortunately, these occurrences are rare. Unfortunately, they can occur and generally necessitate additional surgery. A prosthetic knee component can loosen from the bone due to relative motion between the component and the bone. The intended use of a total knee replacement results in wear of the polyethylene tibial and patellar components. Just as small pieces of rubber wear off an automobile tire when it rolls, the intended motion of the knee replacement generates very small particles of polyethylene. These particles are released into the tissue around the joint. If enough particles are generated, they can cause inflammation. This type of inflammation can result in resorption of the bone around the total knee replacement. This type of bone resorption is called osteolysis and can necessitate additional surgery.

In the event that a total knee fails, it is possible to implant another knee replacement. Such revision total knee replacement surgery may be a lesser or greater operation than the original total knee surgery. Similarly, recovery from revision total knee surgery may be easier or more difficult than it was from the original total knee surgery. In general, the results of revision total knee surgery are not quite as good or predictable as for primary total knee replacements. The results of revision total knee replacement depend on what the problem was that necessitated surgery. Following revision total knee replacement, most patients have good relief of pain and are able to walk as far as they desire.

Surgeons performing Knee Revision Surgery at the Joint Replacement Institute:


Metal/Metal Evaluation
Evaluation of Patients with Hip Resurfacing or a Metal-Metal Bearing Total Hip

Background

metal
Clinical history and laboratory testing demonstrated the low wear potential of metal-metal bearings. The majority of hips today with a metal-metal bearing have low wear and are functioning well. However, it has been recognized that certain circumstances can produce higher wear and higher metal ion production. The patient may not have any pain or other symptoms.

The Evaluation

All patients with a hip resurfacing or a metal-metal bearing total hip should have an annual evaluation by an orthopaedic surgeon. The evaluation should include an interview and an examination, x-rays including a true lateral of the hip, and a blood test for cobalt and chromium ion levels. Depending upon the results of that evaluation, cross-sectional imaging of the hip(s) (ultrasound, CT scan, or metal-artifact reduction MRI scan) may be indicated. If there are concerns about any other organs, a qualified internist can direct additional evaluations.

Recommendations

The fundamental question to be addressed on a case-by-case basis is, does the benefit-to-risk ratio favor a revision surgery or not? The decision to revise has historically been most influenced by 1) how the hip feels and functions and 2) how risky is a revision for that patient? At this time, there is debate regarding the role of cobalt and chromium ion levels in decision-making for revision surgery. Cross-sectional imaging, which can demonstrate reactive changes in the adjacent soft tissues, is of more value in surgical decision-making.

The JRI physicians and staff are knowledgeable and experienced in the evaluation of artificial hip joints, including hip resurfacings and total hips with metal-metal bearings.


Shoulder Joint Replacement

The shoulder is the joint with the largest range of motion in the human body. It is subject to a wide variety of pathologies, because its stabillity is essentially maintained by a complex matrix of ligaments, muscles, and tendons. Shoulder pain can often be treated with a conservative approach unless the cartilage of the joint between the humerus (the upper arm bone) and the scapula (the shoulder blade) is completely worn, in which case a total shoulder replacement is needed.

Non-Operative Treaments

Shoulder pain can have a number of origins. Our surgeons are committed to a conservative approach to treatment and usually explore non-invasive treatment options as a first step. Non-operative treatment options include:

  • Modification of patient activity
  • Physical therapy
  • Oral medications
  • Local injection

Arthroscopy

Arthroscopy is a procedure which utilizes a tiny camera to look inside the shoulder joint. This allows the surgeon to evaluate and treat certain shoulder conditions such as small rotator cuff tears, or to repair or shave any loose bodies that may be floating in the joint. For example, Impingement Syndrome (bursitis) can be treated with arthroscopic removal of bone spurs. Patients having shoulder arthroscopic surgery usually go home the same day, while the length of recovery depends on the specific type of shoulder arthroscopic surgery performed.

Surgeons performing Shoulder Arthroscopy at the Joint Replacement Institute:

Total Shoulder Replacement

Total Shoulder Replacement (also called Total Shoulder Arthroplasty) is the surgical replacement of damaged surfaces of the shoulder joint with a highly polished metal ball attached to a stem and a plastic socket. The goal is to relieve shoulder pain and restore the best possible function to the shoulder joint. The time for recovery after Total Shoulder Replacement is dependent upon the amount of damage to the muscles and tissues of the joint prior to surgery.

Reverse shoulder replacement is a special type of shoulder replacement for people with especially severe shoulder arthritis, very large rotator cuff tears or certain severe shoulder fractures.

Surgeons performing Total Shoulder Replacement at the Joint Replacement Institute:

Subacromial Decompression

Subacromial decompression surgery is used to treat shoulder impingement syndrome, a condition in which the rotator cuff tendon is being pinched between the humeral head and the acromion. This surgical intervention is usually recommended after conservative treatments have failed. Most subacromial decompressions can be performed arthroscopically. Scar tissue and bone spurs are removed and the inferior surface of the acromion cleaned off as well as the distal end of the clavicle if needed.

Surgeons performing Subacromial Decompression at the Joint Replacement Institute:

Rotator Cuff Repair

The rotator cuff is a group of muscles and tendons that hold the arm in its “ball and socket” joint and help the shoulder to rotate and move. The tendons can be torn from overuse or injury.

Rotator cuff repair is a type of surgery to repair a torn tendon in the shoulder. The procedure can be performed as open surgery or through arthroscopy, which uses smaller incisions.

Surgeons performing Rotator cuff repair at the Joint Replacement Institute:

SLAP Repair

The term SLAP stands for Superior Labrum Anterior and Posterior. In a SLAP injury, the top (superior) part of the labrum (the ring of cartilage that surrounds the socket of the shoulder joint) is injured. This top area is also where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can also be involved in this injury.

Surgery may be recommended if pain does not improve with nonsurgical methods. The surgical technique most commonly used for repairing a SLAP injury is arthroscopy.

Surgeons performing SLAP repair at the Joint Replacement Institute:

Shoulder Debridement

Shoulder debridement consists of the removal of debris and damaged tissue in the shoulder joint. This procedure is performed arthroscopically. Your doctor may recommend this procedure if you have damaged tissue in your shoulder joint, and conservative treatments are having no effect.

Surgeons performing Shoulder Debridement at the Joint Replacement Institute:

Fracture Repair

A fractured bone will typically repair itself if the broken extremities of the bone are close enough and maintained immobilized. However, a surgical intervention will often facilitate a fast and complete recovery, depending on the location of the fracture and the degree of displacement between the two (or more) broken parts of the bone.

Bone fracture repair is a surgery usually involving metal screws, pins, rods, or plates to hold the bone in place. It is also known as Open Reduction and Internal Fixation (ORIF) surgery.

Joint Replacement Institute surgeons performing Fracture Repair around the Shoulder joint:


Sports Medicine

Sports medicine encompasses the treatment and prevention of injuries related to sports and exercise. Orthopaedic treatments and procedures constitute a large part of this branch of medicine, and sports medicine physicians use the most advanced technological tools available.

Non-Operative Treatments

At Joint Replacement Institute, non-operative treatments such as physical therapy, trigger point injections, and other modalities can be prescribed to treat acute and chronic injuries. Common conditions treated include, but are not limited to, runner’s knee, ankle sprain and instability, frozen shoulder, shoulder rotator cuff injuries and shoulder instability.

ACL Reconstruction

The Anterior Cruciate Ligament (ACL) is located in the center of the knee and is essential to the stability of the knee joint. A tear of this ligament can cause your knee to give way during physical activity, which could damage the surrounding structures (i.e. other ligaments, cartilage, menisci).

A torn ACL cannot be repaired and must instead be replaced with a tissue graft, which is the goal of ACL reconstruction surgery. Two alternative sources of replacement material for ACL reconstruction are commonly utilized: autografts (tissue harvested from the patient’s body) and allografts (tissue from a donor’s body). ACL reconstruction can be performed arthroscopically or by open surgery.

Surgeons performing ACL Reconstruction at the Joint Replacement Institute:

Knee Arthroscopy

Arthroscopy is a procedure which utilizes a tiny camera to look inside the knee joint. This allows the surgeon to evaluate and treat knee disorders. Arthroscopy requires only small incisions around the knee for the insertion of small instruments that are about the size of a pen or pencil. With arthroscopy, degenerated and worn menisci can be trimmed and smoothed, which reduces one source of inflammation. Additionally, the lining of the knee (the synovium), can be trimmed, and this also decreases inflammation. Patients who have knee arthroscopy go home the same day. Recovery from surgery occurs over a couple of weeks.

Surgeons performing Knee Arthroscopy at the Joint Replacement Institute:

Knee Lateral Release

Knee pain can be produced by tight capsular structures (retinaculum) on the outer aspect (lateral aspect) of the kneecap. In this case, the kneecap does not slide well within the groove of the lower part of the femur and cartilage irritation can result.

A lateral release is a procedure performed to cut through this tight retinaculum, and allow the kneecap to sit properly within its groove during motion. The release may be done with open surgery or arthroscopically, depending on the surgeon’s preference and experience.

Whether open or arthroscopic, success of the lateral release depends more on proper patient selection than on the technique used.

Surgeons performing Knee Lateral Release at the Joint Replacement Institute:

Knee Meniscal Repair

The menisci are pieces of cartilage that act like a cushion between the tibia and the femur. A torn meniscus may heal on its own if the tear is small enough. However more severe tears will require a surgical solution involving either the repair of the tear if the lesion is located in a part of the meniscus that receives good blood supply, or the removal (partial meniscectomy) of the affected region.

Knee Meniscal repair can be performed arthroscopically, which favors fast recovery times compared with open surgery.

Surgeons performing Meniscal Repair at the Joint Replacement Institute:

Shoulder Arthroscopy

Arthroscopy is a procedure which utilizes a tiny camera to look inside the shoulder joint. This allows the surgeon to evaluate and treat certain shoulder conditions such as small rotator cuff tears, or to repair or shave any loose bodies that may be floating in the joint. For example, Impingement Syndrome (bursitis) can be treated with arthroscopic removal of bone spurs. Patients having shoulder arthroscopic surgery usually go home the same day, while the length of recovery depends on the specific type of shoulder arthroscopic surgery performed.

Surgeons performing Shoulder Arthroscopy at the Joint Replacement Institute:

Shoulder Reconstruction (Dislocation Repair)

After a shoulder dislocation or subluxation (a partial dislocation), the shoulder joint can be left unstable and more prone to other dislocations. This instability is usually related to a stretching or tearing of the static stabilizers (labrum, capsule and ligaments) that occurred during the dislocation. Shoulder instability usually requires Shoulder Reconstruction Surgery because further damage to the shoulder joint is likely to occur if left untreated.

Shoulder Reconstruction is a repair of the static stabilizers and can be performed both arthroscopically or as open surgery depending mainly on the extent of damage already present in the joint.

Surgeons performing Shoulder Reconstruction at the Joint Replacement Institute:

Rotator Cuff Repair

The rotator cuff is a group of muscles and tendons that hold the arm in its “ball and socket” joint and help the shoulder to rotate and move. The tendons can be torn from overuse or injury.

Rotator cuff repair is a type of surgery to repair a torn tendon in the shoulder. The procedure can be performed as open surgery or through arthroscopy, which uses smaller incisions.

Surgeons performing Rotator Cuff Repair at the Joint Replacement Institute:

Achilles Tendon Repair

Even though the Achilles tendon is the strongest tendon in the human body, its rupture is a fairly common injury in healthy, young, active individuals. Surgical repair is usually the treatment of choice because it is associated with a lower rate of re-injury and shorter recovery time compared with non-surgical treatments.

Surgical repair can be performed with a closed or an open technique. With the open technique, an incision is made to allow for better visualization and approximation of the tendon. With the closed (also called percutaneous) technique, the surgeon makes several small skin incisions through which the tendon is repaired. A short leg cast (plaster) is placed on the operated ankle after either of the procedures.

Surgeons performing Achilles Tendon Repair at the Joint Replacement Institute:

Labral Repair

The socket of the shoulder joint is extremely shallow to allow maximum range of motion, and thus, is inherently unstable. Extra support to adequately hold the bones of the shoulder in place is provided by the labrum, a cuff of cartilage that circles the shoulder socket to make it deeper.

A torn labrum from a shoulder injury will need surgical repair if nonsurgical treatments fail to relieve pain. Most labral surgeries are now done arthroscopically and involve labrum debridement (removal of frayed edges and loose parts) and/or labral reattachment to the bone.

Surgeons performing Labral Repair at the Joint Replacement Institute:

Fracture repair

A fractured bone will typically repair itself if the broken extremities of the bone are close enough and maintained immobilized. However, a surgical intervention will often facilitate a fast and complete recovery, depending on the location of the fracture and the degree of displacement between the two (or more) broken parts of the bone.

Bone fracture repair is a surgery usually involving metal screws, pins, rods, or plates to hold the bone in place. It is also known as Open Reduction and Internal Fixation (ORIF) surgery.

Joint Replacement Institute surgeons performing general Fracture Repair:


Frequently Asked Questions


Making Your First Appointment

  • How do I make my first appointment with a physician at JRI?

    Please call the main telephone number to Joint Replacement Institute at (213) 484-7600.  If you do not know which physician to make your appointment with, the receptionist will help you choose the appropriate physician for you.  Please have your insurance card available when you make this call.  We will need the insurance company name, the ID number on your card, the group number and the insurance phone number.  You can also e-mail a request for an appointment to JRIinfo@verity.org.  Please provide the above information with your request.

  • What other information will I need to provide?

    You will be sent a “new patient” packet to be completed and hand carried with you to your first appointment.  The packet includes forms to be filled out regarding your current medical history, personal/demographic information, financial responsibility document and other legal documents.  Please be sure to include all of the current medications you are taking on the “current medications” sheet.

    View new patient packet for each doctor to download all necessary forms.

  • How long before my appointment time should I arrive for my first visit?

    Please arrive 15 minutes early to allow for the registration process. Having your forms completed prior to your visit will expedite this process.  If you did not receive and/or complete your forms, plan on arriving 30 minutes prior to your appointment.

  • What else should I bring for the first appointment?

    Please bring your drivers license or state ID, insurance card (primary and/or secondary insurance cards), and current x-rays should you have these in your possession.


Telephone Consultation


Cash Patients with No Insurance Coverage


FAQs – Surgery

  • What is the process for insurance approval once it is determined that I need surgery?

    Depends on insurance: HMO – this can vary from 7 to 30 days; PPO – precertification process could be anywhere from 3-7 business days depending on your type of surgery.

    If this is a hip resurfacing, this process may take longer. If the request for hip resurfacing surgery is denied it is your responsibility to initiate an appeal with your insurance carrier.

  • How soon can my surgery be scheduled once my surgery is approved by my insurance?

    Once your surgery is approved, scheduling will be coordinated to fit both your schedule and the surgeon’s availability.

  • If I proceed with surgery, what amount will my insurance company pay? How much will I be paying out of pocket?

    Please contact your insurance company and speak with a customer service representative who can give you detailed information about your coverage.

  • Will I need to see the surgeon for a pre-op appointment?

    Yes.  These appointments will be coordinated by the assigned surgery coordinator.

  • When can I have dental work done?

    NO dental work 14 days prior to surgery and 90 days after surgery.  You will need to have antibiotics given by your dentist with any dental work, even a routine cleaning.  Your surgeon will tell you how long after your surgery (how many years) you will need to take antibiotics at the time of dental work.  If your dentist is not able to prescribe the antibiotic, please call our office for instructions.

    For emergency dental work (broken tooth, etc.) – please call for instructions: an antibiotic will be prescribed.

  • What medications should I stop before my surgery?

    This will be outlined in your surgery packet.  You will need to discontinue all anti-inflammatory medications. These include: ibuprofen, motrin, aspirin, and all aspirin containing products such as Alka Seltzer, Bufferin, Anacin, Pepto-Bismol; all anti-inflammatories such as Indocin, Naprosyn (Aleve), and Tolectin, Herbal products such as St. John’s Wort, Arnica or Ginkgo Biloba.

    Note: Coumadin & other blood thinners must be discussed with your primary care physician (PCP) before surgery.

  • What can I take for pain prior to my surgery?

    Tylenol with Codeine, extra strength Tylenol, Tylenol PM, or what your primary care physician or surgeon prescribes.

  • How many days is the hospital stay?

    Two to three days. It also depends on how many days your insurance authorized, and how well you progress after your surgery.


After Your Surgery

  • When can I shower after surgery?

    You can shower any time but the JRI physicians recommend that you do not get the incision wet until post-op day 5.  Keep the incision covered with a water-proof dressing while in the shower until post-op day 5.  After that, it is OK to get the incision wet in the shower but do not submerge the incision in a bath tub, pool, hot tub, etc. until 3 weeks after surgery.

    If there is drainage from the incision site after your discharge home, you should not shower and should call the clinic to notify the staff.  Our staff will notify the physician assistant or surgeon for further instruction.

  • When does the dressing need to be changed?

    The dressing can be changed any time it looks soiled or becomes wet after a shower.

  • Should the steri-strips be removed?

    No, they will peel away and fall off naturally on their own.  Trimming the ends that may curl up with a small pair of scissors will help keep them from snagging on clothing.  Do not pull the strips over the incision.  Wait for them to fall off.

  • What should I do for swelling in my legs after surgery?

    Take short walks several times a day.  Elevate your legs when resting.  Avoid prolonged (>30 minutes) periods of sitting.  Ice can be applied over the surgical area for 20 minutes, once each hour.  Please do not apply ice directly to skin.

  • How long will I be wearing white compression stockings?
    Usually not required. Please ask your surgeon.
  • How long will I need to use crutches/walker?

    It varies with each patient. Most patients will use crutches for 2-3 weeks then transition to either 1 crutch or a cane for the next week or two. The decision to wean from the crutches is based on your level of comfort.  Never walk without support if you are limping!!

  • After surgery how long do I need to wait to come back and see the surgeon?

    Typically at 6 weeks post-op with MD and have x-rays taken. (Between 2-6 weeks, will be seen by PA only)

    Note: Out of town post-op patients should mail their x-rays to JRI at 6 weeks. Your surgeon will call you to review your x-rays.

  • Who will provide my P.T. prescription and when?

    A prescription for Physical Therapy will be enclosed in your pre-operative packet that you receive prior to surgery.  Please call the office if you did not receive one.

  • When do I begin my physical therapy after surgery?

    Plan to begin your therapy as soon as you are discharged.

    If you live close to St. Vincent Medical Center you may wish to come to the Physical Therapy Department here.  If so, call (213) 484-7937 to make an appointment.

    If not, make an appointment with a facility of your choice.

  • When can I start driving?

    After you are off narcotic pain medication. The doctor cannot legally authorize you to drive. This decision is ultimately up to each patient, and depends on which side you had the surgery. Since the gas/brake pedal is on the right side, patients with surgery on this side usually require more time. Check with your auto insurance liability policy to see if there’s a clause that discludes coverage for any period of time after major surgery.

    For example: Left hip/knee patients need to be off medications. Right hip/knee patients need to have good control of the right leg and must be off medications.

  • Where do I get my disability forms?

    From your employer or for California residents, go on-line to the Employment Development Department at www.edd.ca.gov.  Please fill out your portion of the form completely and submit to the Medical Assistant.  Be sure to sign and date your forms.

  • After my discharge from the hospital, when is it important for me to call the office?

    Call the office if you:

    • Develop a fever of 101 degrees or higher.
    • Experience drainage from your surgical wound site.
    • Have unusual pain in your calf or behind your knee.
    • Experience swelling in your leg(s) that does not go down after elevating your leg(s) (ankles higher than heart level).

Thomas P. Schmalzried, MD

Schmalzried's photo

Thomas P. Schmalzried, MD

English

 

Education

  • Hip and Implant Fellowship
    Harvard University, MA [ 1990 - 1991 ]
  • NIH Research Fellowship in Joint Replacement
    University of California Los Angeles, CA [ 1986 - 1987 ]
  • Orthopedic Residency
    University of California Los Angeles, CA [ 1985 - 1990 ]
  • Surgery Internship
    University of California Los Angeles, CA [ 1984 - 1985 ]
  • Doctor of Medicine
    University of California Los Angeles, CA [ 1984 ]
  • Bachelor of Arts Human Biology
    Stanford University, CA [ 1980 ]

Licensure and Certifications

  • American Board of Orthopedic Surgery [ Jul 9, 1993 - Dec 31, 2023 ]
  • Medical License, California
  • California DEA

Professional Society Memberships

  • Orthopedic Research Society
    Local Area Host, 1999, Board of Directors, 2000-2003
  • California Orthopedic Association
  • American Academy of Orthopedic Surgeons
    Board of Directors, 1998-2000
  • Orthopedic Research and Education Foundation
    Board of Directors, 2008-Present
  • Western Orthopedic Association
    Board of Directors, 1996-1997
  • CAP-MPT Education Committee, 1998-2001
  • The Hip Society
    Membership Committee Chair, 2007-2008
  • Association of Arthritic Hip and Knee Surgeons
    Board of Directors, 2000-2003
  • The American Orthopedic Association
    Critical Issues Committee, 2001-2003
  • Orthopedic Research and Education Foundation
    Trustee, 2008-2015
  • The Knee Society

Publications

View list of publications on PubMed

 

 

H. Michael Mynatt, MD

Mynatt's photo

H. Michael Mynatt, MD

English

 

Education

  • Residency
    Medical College of Wisconsin, WI [ 79 ]
  • Internship
    University Hospital, San Diego, CA [ 73 ]
  • Doctor of Medicine
    Marquette School of Medicine, WI [ 1974 ]
  • Bachelor of Arts
    University of Southern California, CA [ 1968 ]

Licensure and Certifications

  • American Board of Orthopedic Surgery [ 1981 ]
  • Medical License, California

Professional Society Memberships

  • American Academy of Orthopedic Surgeons
  • American Association of Hip and Knee Surgeons
  • Northwest Medical Association
  • USC Graduate Orthopaedic Society

 

 

William T. Long, MD

Long's photo

William T. Long, MD

https://www.orthocsi.com/dr-long

English, Spanish

 

Education

  • Arthritis and Joint Replacement Fellowship
    University of Southern California University Hospital, Los Angeles, CA [ Nov 92 - Jul 93]
  • Arthritis and Joint Replacement Fellowship
    Kerlan - Jobe Orthopedic Clinic, Centinela Hospital, Inglewood, CA [ Jul - Nov 92 ]
  • Orthopedic Surgery Residency
    Martin Luther King/Charles Drew Medical Center, Los Angeles, CA [ 87 - 92 ]
  • Biomechanics Research Laboratory Research Fellow
    King/Drew Medical Center, Centinela Hospital, Los Angeles, CA [ 86 - 87 ]
  • General Surgery Internship
    Rush Presbyterian - St. Lukes Medical Center, Chicago, Illinois [ 85 - 86 ]
  • Doctor of Medicine
    San Diego School of Medicine, University of California, LaJolla, CA [ 81 - 85 ]
  • Bachelor of ScienceMajor in Biology
    California State University, Hayward, CA [ 77 - 81 ]

Licensure and Certifications

  • American Board of Orthopedic Surgery [ Jul 13, 1992 - Dec 31, 2027 ]
  • National Medical Boards (Part I, II, III)
  • Radiography and Fluoroscopy X-ray Supervisor, and Operator State of California
  • Physician Assistant Supervisor, State of California
  • Medical License, California (Current)
  • Medical License, Washington (Inactive)

Professional Society Memberships

  • AAHKS Knee Society
  • The American Orthopedic Association (AOA)
  • American Academy of Orthopedic Surgeons
  • California Orthopedic Association
  • Charles R. Drew University of Medicine and Science Alumni Association
  • Lawrence Dorr Fellows Society
  • National Medical Association
  • Western Orthopedic Association
  • Charles R. Drew Medical Society

Publications

View list of publications on PubMed

 

 

Christopher C. Goring, MD

Goring's photo

Christopher C. Goring, MD

https://www.orthocsi.com

English, Spanish

Dedicated Surgeon with diverse professional background that includes military and civilian training. Solid knowledge and experience working with trauma and sports patients. Heightened awareness of global healthcare needs, stemming from deployment to Iraq and volunteer efforts in native Guyana. Record of success collaborating with teams to improve patient care, increase revenues and improve overall operating efficiency. Relationship manager who works well with all levels of an organization to achieve desired results.

 

Education

  • Adult Joint Replacement Fellowship
    Keck School of Medicine, University of Southern California [ 2013 - 2014 ]
  • Orthopedic Surgery Residency
    Tripler Army Medical Center, Honolulu, HI [ 1998 - 2003 ]
  • Transitional Internship
    Tripler Army Medical Center, Honolulu, HI [ 1995 - 1996 ]
  • Doctor of Medicine
    Yale University School of Medicine, New Haven, CT [ 1995 ]
  • Bachelor of Science in Biology
    Brown University, Providence, RI [ 1991 ]
  • Dual Enrollment ProgramProvidence College Army ROTC, Providence, RI [ 1991 ]

Licensure and Certifications

  • Orthopedic Surgery
  • Medical License, California (Current)
  • Medical License, Michigan (Current)
  • Medical License, Vermont (Current)

Publications

View list of publications on PubMed

 

 

Jalaal A. Shah, DO

Shah's photo

Jalaal A. Shah, DO

English

 

Education

  • Joint Replacement Fellowship
    Joint Replacement Institute at St. Vincent Medical Center, Los Angeles, CA [ 2018 ]
  • Orthopedic Residency
    Midwestern Unviersity/Franciscan St. James Health, Chicago, IL [ 2017 ]
  • Doctor of Osteopathic Medicine
    Chicago College of Osteopathic Medicine, Midwestern University, Downers Gove, IL [ 2012 ]
  • Bachelor of Science Mechanical Engineering
    Northeastern University, Boston, MA [ 2006 ]

Licensure and Certifications

  • American Osteopathic Academy of Orthopedics: Board Eligible. Parts 1 and 2 Complete.
  • Osteopathic Medical Board of California, Medical License Feb 2017 (Active)
  • ATLS/ACLS Certified

Professional Society Memberships

  • American Academy of Orthopedic Surgeons
  • American Osteopathic Academy of Orthopedics
  • American Association of Hip and Knee Surgeons
  • AO Trauma Foundation
  • American Osteopathic Association
  • National Society of Mechanical Engineers

Publications

View list of publications on PubMed

 

 

Harlan C. Amstutz, MD

Amstutz's photo

Harlan C. Amstutz, MD

English

 

Education

  • Orthopedic Residency
    Hospital for Special Surgery, New York, NY [ 1961 ]
  • Surgical Residency
    University of California Los Angeles, CA [ 1958 ]
  • Internship
    Los Angeles County General Hospital, CA [ 1957 ]
  • Doctor of Medicine
    University of California Los Angeles, CA [ 1956 ]
  • Bachelor of Arts
    University of California Los Angeles, CA [ 1953 ]

Licensure and Certifications

  • American Board of Orthopedic Surgery [ 1981 ]
  • Medical License, California

Professional Society Memberships

  • American Academy of Orthopedic Surgeons Orthopaedic Research Society
  • New York Academy of Sciences
  • American Society for Testing and Materials American College of Surgeons
  • American Medical Association
  • New York Academy of Medicine
  • Association of Bone and Joint Surgeons
  • American Rheumatism Association
  • Academic Orthopaedic Society
  • Association for the Advancement of Medical Instrumentation
  • The Hip Society
  • The International Hip Society
  • California Medical Association
  • Western Orthopaedic Association
  • American Orthopaedic Association
  • Society for Biomaterials
  • Mid America Society (Honorary Member)
  • Asociacion Argentina Orthopedia y Traumatologia (Honorary)
  • Association Research Circulation Osseous
  • American Institute for Medical and Biological Engineering (AIMBE)
  • American Association of Hip and Knee Surgeons (AAHKS)
  • National Osteonecrosis Foundation, Inc.

Publications

View list of publications on PubMed

 

 

Jonathan R. Saluta, MD

Saluta's photo

Jonathan R. Saluta, MD

laorthocenter.com | www.orthodoc.aaos.org/jonathansaluta

English, Medical Spanish

 

Education

  • Orthopedic Foot and Ankle Surgery Fellowship
    Duke University Medical Center, NC [ 2006 ]
  • Orthopedic Surgery Residency
    Medical College of Virginia, VA
  • Surgery Internship
    Medical College of Virginia, VA
  • Doctor of Medicine
    University of North Carolina School of Medicine, NC [ 2000 ]
  • Bachelor of Science Biochemistry, Biology
    North Carolina State University, NC [ 1993 ]

Licensure and Certifications

  • American Board of Orthopedic Surgery
  • Medical License, California

Professional Society Memberships

  • American Academy of Orthopedic Surgeons
  • American Orthopaedic Foot and Ankle Society
  • Piedmont Orthopaedic Society
  • California Orthopaedic Association

Publications

View list of publications on PubMed

 

 

Brian H. Itagaki, MD

Itagaki's photo

Brian H. Itagaki, MD

English

 

Education

  • Spine Surgery Fellowship
    Rancho Los Amigos, Downey, CA [ 1983 ]
  • Orthopedic Surgery Residency
    University of California, Irvine, CA [ 1982 ]
  • Surgery Internship
    University of California, Irvine, CA [ 1978 ]
  • Doctor of Medicine
    University of Hawaii, Honolulu, HI [ 1977 ]
  • Master of Science Mathematics
    University of Illinois, Champaign, IL [ 1969 ]
  • Bachelor of Arts Mathematics
    University of Hawaii, Honolulu, HI [ 1968 ]

Certifications

  • American Board of Orthopedic Surgery
  • X-Ray Supervisor and Operator Radiography & Fluoroscopy
  • Qualified Medical Evaluator

Licensure

  • Medical License, California (Current)

Professional Society Memberships

  • American Medical Association
  • California Medical Association
  • American Academy of Orthopedic Surgeons
  • Los Angeles County Medical Association
  • California Orthopedic Association
  • Japanese American Medical Association

 

 

Marc A. Samson, MD

Samson's photo

Marc A. Samson, MD

English, Italian, Medical Spanish

 

Education

  • Sports Medicine Fellowship
    SOAR, Stanford University, CA [ 1997 ]
  • Orthopedic Surgery Residency
    Boston University, MA [ 1997 ]
  • Orthopedic Surgery Residency
    New York Medical College and Westchester County Hospital, NY [ 1995 ]
  • Surgery Internship
    New York Medical College and Metropolitan Hospital, NY [ 1993 ]
  • Doctor of Medicine
    University of California Irvine, CA [ 1992 ]
  • Bachelor of ArtsBiology
    University of California Berkeley, CA [ 1988 ]

Licensure and Certifications

  • American Board of Orthopaedic Surgery [ 2020 ]
  • American Board of Orthopaedic Surgery, Sports Medicine [ 2019 ]
  • Medical License, California

Professional Society Memberships

  • American Academy of Orthopedic Surgeons