Author Archives: Tigran Garabekyan, M.D.

Orthopedic surgery is a treatment to address injuries and various other conditions of the musculoskeletal system. The musculoskeletal system comprises of the joints, bones, and the following adjacent soft tissues: muscles (which offer protection and allow bone and joint movement), ligaments (which connect the bones), and tendons (which link the muscles to the bones).

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides various orthopedic treatments to patients in North Hollywood, Los Angeles, and surrounding communities in this area of The Golden State.

Common Orthopedic Surgeries

A majority of orthopedic surgery procedures are performed on the knee, elbow, ankle, shoulder, wrist, hip, and spine. These procedures can be performed either with traditional open surgery or arthroscopically using an arthroscope.

Following are some of the most common orthopedic surgery procedures:

• Ankle: Surgery to repair ankle fracture.

• Knee: Knee arthroscopy (chondroplasty, anterior cruciate ligament reconstruction, meniscectomy) and knee replacement procedures.

• Hip: Surgery to repair a trochanteric fracture, femoral neck fracture, and hip replacement.

• Wrist: Surgery for wrist bone (distal radius) fracture repair, carpal tunnel release

• Shoulder: Shoulder arthroscopy (distal clavicle excision, rotator cuff tendon repair, decompression)

• Spine: low back intervertebral disc surgery, lumbar spinal fusion, laminectomy
• Bones: thigh bone (femoral shaft) fracture repair, forearm (radius) bone fracture repair

Arthroscopy

Arthroscopy is a minimally invasive option to traditional open surgery techniques. It is the most frequently performed surgery in the US. Orthopedic surgeons utilize this technique to visualize, diagnose, and address issues within a joint.

During an arthroscopic exam, an orthopedic surgeon places a tiny incision on the patient’s skin. They then insert pencil-sized instruments that comprise a small lens and lighting mechanism to magnify and light up internal joint structures. Fiber optics help transmit light to the end of the arthroscope which is inserted in the joint.

Through connecting the arthroscope to a tiny camera, the surgeon can visualize the joint interiors through a small incision instead of a more substantial incision required for surgery.

The camera that is attached to the arthroscope presents the joint’s image on the monitor. This enables the surgeon to look at the ligaments, cartilage, and beneath the kneecap. The surgeon can establish the type and intensity of the injury allowing them to treat the problem, if necessary.

Ankle Surgery

If severe arthritis causes persistent ankle pain, which cannot be relieved by conservative treatment options, the orthopedic surgeon may recommend ankle surgery. In case of a severely damaged ankle joint, the bones may have to be fused together, or sometimes a replacement with an artificial joint may be necessary.

Knee Replacement Surgery

Knee arthroplasty or replacement surgery can help to provide relief from pain and restore function of a severely damaged knee joint. The surgery involves cutting away the damaged cartilage and bone from the kneecap, shinbone and thighbone to replace it with an artificial joint.

Reliable orthopedic surgeon Dr. Tigran Garabekyan of SCHI receives patients from North Hollywood, Los Angeles, and other towns and suburbs in this region of the southwest for various types of orthopedic surgery procedures.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

North Hollywood: 818.755.6500
Century City / Los Angeles: 310.574.0375

Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

Patients with clinical and radiographic evidence of intra-articular hip pathology can benefit from non-image-guided diagnostic hip injections. This is a critical finding from a new study, which was co-authored by board certified orthopedic surgeon Dr. Tigran Garabekyan of the Southern California Hip Institute (SCHI).

Download the Full Study

Objective of the Study

The objective of this study was to determine the likelihood of pain relief, as a measure of accurate diagnosis of intra-articular hip pathology and correct needle placement, with a non-image-guided intra-articular hip injection performed bedside in the clinic.

While previous studies have demonstrated significantly improved accuracy, pain, and functional outcomes for image-guided versus palpation-guided injections, knee, shoulder and elbow joints, these image-guided injections present two challenges:

• Increased cost to patients
• Time lost between presentation and established diagnosis

The current non-image-guided technique addresses both these parameters.

Pain Relief in 98.7% of Cases

During the study period, 809 injections were performed in an office setting. The final study cohort comprised 142 patients (161 hips), of whom 120 hips (74.5%) were female.

Mean patient age was 38.8 years. In three cases, patients were unable to assess or quantify any change in overall pain level following the injection. In the remaining 158 hip injections, pain relief was noted in 156 cases (156/158, 98.7%), with at least 70% improvement in pain level noted in 152 cases (152/158, 96.2%). No post-injection hematomas occurred in the group.

Majority of Patients Experienced 90-100% Pain Relief

Based on the results of this study, non-image-guided intra-articular hip injections can provide substantial pain relief to the majority of patients who had clinical and radiographic evidence of intra-articular hip pathology.

This bedside technique, unencumbered by use of an image guidance, may be used to endorse suspected intra-articular pathology or provide short-term treatment with the inclusion of steroid medication.

In the present study, the average pain relief experienced by all patients was 89%, with the majority of patients experiencing 90–100% pain relief. Lack of complete pain relief after an intra-articular injection of lidocaine may be related to extra-capsular and surrounding musculature inflammation resulting directly or indirectly from the intra-articular pathology.

All six patients who reported less than 70% improvement in their pain following a non-image-guided hip injection were later confirmed to have an extra-articular pain source, thereby explaining the incomplete pain relief experienced by these patients.

Other Benefits of Non-Image-Guided Hip Injections

The non-image-guided hip injections performed in this study were well- tolerated by patients after a local anesthetic injection of lidocaine. These injections provide convenience to patients who present with joint or periarticular pain.

Patients may undergo a full assessment (with physical examination and radiographic imaging) and get confirmation of the cause of their pain during one visit with the use of diagnostic local anesthetic injections.

Furthermore, in patients who do not experience pain relief with a diagnostic hip injection, the provider can immediately prepare for further evaluation or diagnostic tests rather than delaying this process by several days or even weeks.

In many cases, this can yield significant savings in both time and monetary cost for patients. When these injections are performed by a radiologist, it is much more difficult for the patient to remember the efficacy of the injection by the time the patient follows up with the surgeon.

For team physicians, non-image-guided intra-articular injections may provide quick and temporary pain relief to allow immediate return to play for athletes.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

North Hollywood: 818.755.6500
Century City / Los Angeles: 310.574.0375

Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

Following spinal stenosis surgery, the patient will most likely be out of their bed within 24 hours, though pain medications will continue for a period of two to four weeks. The patient will receive guidelines on how to cautiously stand, sit, and rise post-surgery.

It is essential that the body gets sufficient time and rest to heal properly. Until the initial healing is completed, the patient should not engage in any activities that cause the spine to move frequently. The patient should also not indulge in heavy lifting or contact sports in the recovery phase.

Board certified orthopedic surgeon Dr. Tigran Garabekyan of Southern California Hip Institute (SCHI) provides orthopedic surgery and other procedures to patients in North Hollywood, Los Angeles, and surrounding locations.

Recovery Duration for Minimally Invasive Spinal Stenosis Decompression Surgery

The minimally invasive decompression procedure may involve a 12-week recovery period. Before the surgery, the surgeon will provide post-op care instructions to assist the patient in a faster and safer recovery.

Professional care and advanced surgical techniques help patients to enjoy successful surgical results and resume their lives faster than they had thought possible.

Some facts about the successful results of a minimally invasive decompression procedure are:

• Almost 80 percent of patients return to work within a period of three months after the surgery.
• Almost 90 percent of patients resume their daily activities within a period of three months after the surgery

The patient should remain in touch with the surgeon’s office during the recovery phase. They should speak to the administrative staff if they experience any sudden discomfort during the recovery.

Recovery Period for Minimally Invasive Stabilization Surgery for Spinal Stenosis

A significant advantage with minimally invasive spinal stenosis stabilization procedure is that it usually has a 12-week timeframe for healing in comparison to between six months and one year for a traditional open back fusion. The patient should contact the surgeon’s office if they have any concerns during the healing period.

The type of spinal stenosis procedure that a patient undergoes determines the particular restrictions and care guidelines for the recovery period. The patient will receive post-operative instructions before their surgery to ensure that they know what to expect during the recovery.

Suggestions for Recovery

The patient must be vigilant after the surgery. They should report any issues such as increased pain, fever, or infection to the surgeon immediately.

Post-surgery, the patient should:

• Follow the surgeon’s instructions for the recovery
• Sit and stand correctly as advised by the surgeon
• Learn how to lift properly
• Exercise routinely (Low-impact aerobic workouts are particularly good, but the patient must check with the doctor before exercising)
• Use the correct sports equipment
• Maintain optimal body weight
• Eat a well-balanced diet that is low-fat and contains adequate amounts of fruits and vegetables as well as calcium
• Quit smoking for at least a specified time period
• Avoid excessive consumption of alcohol

Dedicated orthopedic surgeon Dr. Garabekyan receives patients from North Hollywood, Los Angeles, and nearby areas for orthopedic surgery and other procedures.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

North Hollywood: 818.755.6500
Century City / Los Angeles: 310.574.0375

Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

The cost is a critical factor to consider in any surgical procedure. However, orthopedic surgery procedures are usually performed only when it is clear that non-surgical treatments will not work, or non-invasive therapies have failed to provide relief.

At the time of initial consultation, the surgeon or their team will discuss the estimated costs involved in a procedure.

While the financial ramifications are often covered by insurance for the most part, it is important for a patient to be aware of all cost components in order to make an informed decision. Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides advanced treatments to patients in North Hollywood, Los Angeles, and surrounding locations in The Golden State.

Factors Affecting the Sticker Price

The cost of an orthopedic surgery procedure can vary from one practice to another as well as from one patient to another at the same practice. The following factors will influence the costs:

Practice Location

Practices located in main metropolitan areas and leading urban centers often have to bear higher real estate costs and other overheads. This can reflect to an extent in their prices for all kinds of orthopedic procedures. A practice located in a small town in an interior region might be able to offer slightly lower prices.

Anesthesia Fees

A major orthopedic surgery may require general anesthesia, which will involve the fee of the anesthesiologist or a registered nurse anesthetist. This fee can vary according to their skills and experience as well as the number of hours they may be required to spend in the surgery room.

Surgical Venue

Orthopedic surgery procedures may be performed at a hospital, an accredited surgical center or a private surgical suite. The financial implications and benefits associated with each option will vary.

Diagnostic Exams and Medications

Accurate diagnosis is critical to receiving appropriate orthopedic treatment. Some patients may have to go through MRI and other advanced diagnostic exams that will add to the overall monetary amount of the procedure. Prescription pain medications and drugs may be required before and after the surgery. Their dollar costs should be accounted for while making a cost estimate for orthopedic surgery.

Non-Surgical Treatment, Rehab and Physical Therapy

An orthopedic surgery procedure will almost always be followed by a period rehab and physical therapy. If the services of a professional physical therapist are involved, it will have additional costs. Non-surgical treatments may sometimes be combined with surgery, which will also add to the overall price tag of the procedure.

Insurance

Orthopedic surgery is usually treated as a medical necessity, and most or all of the costs may be covered under the patient’s health plan. The patient should get in touch with their insurance provider and seek information about their benefits. They should arrange medical records from the surgeon for insurer, and acquire the necessary documents from the insurer that the surgeon may have requested.

Insurance plans may also cover the costs of diagnostic exams, physical therapy and prescription drugs. Committed orthopedic surgeon Dr. Garabekyan receives patients from North Hollywood, Los Angeles and nearby areas across the horizon.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

North Hollywood: 818.755.6500
Century City / Los Angeles: 310.574.0375

Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

Spinal stenosis is a serious condition that should be diagnosed and treated in a timely manner. To receive a correct diagnosis of spinal stenosis, the patient may consult with an experienced orthopedic surgeon for a detailed evaluation.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery and other treatments to patients in North Hollywood, Los Angeles, and surrounding communities across the horizon.

Diagnostic Process

Arriving at a diagnosis to identify the cause of pain for spinal stenosis or any other condition typically involves three core steps:

Discussion of Symptoms and Review of Medical History

The surgeon will ask the patient for details regarding their symptoms, lifestyle, previous treatments, diet and various similar questions during the question-and-answer session. The objective is to determine the possible reasons behind the patient’s discomfort. The surgeon will also inquire about the medical history of the patient’s family because many causes of back and neck pain can be inherited.

Physical Exam

The surgeon will put a gentle pressure on the back and neck, test the range of motion, assess neurological function and determine the location of the pain to comprehend the reason behind the symptoms. While this process can cause mild discomfort, it provides vital information. The surgeon will investigate specific signs such as numbness, muscular weakness, areas of sensory abnormalities, and irregular reflexes.

Medical Imaging

An accurate diagnosis of spinal stenosis often requires medical imaging. A CT scan or MRI offers an inside perspective of the spinal column and highlights the exact reason behind the narrowing, such as herniated disc material or a bone spur. Some types of image testing are:

X-Ray

Plain x-rays are done initially. They are useful in locating tumors, infections, and determining issues with spinal alignment. They can help identify fractures, narrowed disc space, bone spurs (osteophytes), osteoarthritis (spondylosis).

MRI

Today, MRI is the leading technology used to diagnose spinal stenosis. The MRI relies on electromagnetic signals to generate spinal images. In comparison to CT scans or X-rays, MRIs are more efficient as they display a higher number of structures such as muscles, nerves, and ligaments.

CT Myelogram

In this test, the patient will have a special dye injected into the fluid in the spine around the nerves and spinal cord. Before the dye is injected, the area is numbed. The patient will then undergo a CT scan. The resulting image will offer a comprehensive anatomic visual of the spine, specifically of the nerves and bone surrounding them. The doctor will try to identify compressed locations or areas of pressure on the nerves. CT scans along with myelography are especially useful in the diagnosis of lumbar spinal stenosis.

Bone Scan

This scan will assist the doctor in identifying spinal issues such as fractures, infections, and osteoarthritis. The doctor will inject the patient with a minuscule amount of radioactive substance into a blood vessel. This will travel through the patient’s bloodstream and be absorbed by the bones. Areas with abnormal activity such as inflammation will incorporate more radioactive material.

Reliable orthopedic surgeon Dr. Garabekyan of SCHI receives patients from North Hollywood, Los Angeles, and other towns and suburbs in this part of SoCal for orthopedic surgery and other procedures.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

North Hollywood: 818.755.6500
Century City / Los Angeles: 310.574.0375

Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

Spinal Stenosis Treatment

The treatment for spinal stenosis will be determined according to the patient’s symptoms and as well as the location of the stenosis. The surgeon will explain all aspects of the procedure to the patient during the initial consultation.

Dependable board certified orthopedic surgeon Dr. Tigran Garabekyan of Southern California Hip Institute (SCHI) provides orthopedic surgery and other procedures to patients in North Hollywood, Los Angeles, and surrounding communities in The Golden State.

Medications

The surgeon may prescribe the following drugs depending on the symptoms:

• Opioids
• Anti-seizure medication
• Pain relievers
• Anti-depressants

Physical Therapy

A physical therapist’s services may be utilized to train the patient in exercises that can assist in:

• Building strength and endurance
• Maintaining the stability and flexibility of the spine
• Improving balance

Steroid Injections

The patient’s nerve root may become inflamed and irritated in the areas that are being pinched. Injecting a steroid medication, known as corticosteroid, into the area around the affected location will not heal the stenosis. However, it helps in reducing pain and inflammation at the site of the stenosis.

Decompression Procedure

This procedure entails using a fine, needle-like tool to remove a part of the thickened ligament in the back of the spinal column. This increases the canal space and addresses nerve root impingement. Patients suffering from thickened ligament and lumbar spinal stenosis only are eligible for a decompression procedure.

Surgery

The patient may consider surgery if various other treatments have been ineffective or if they feel disabled by stenosis symptoms. The objectives of surgery include reducing the pressure on the nerve roots and spinal cord by surgically creating additional space in the spinal canal. Surgery is a definitive stenosis decompression treatment which aims to address the symptoms of the spinal stenosis.

Some procedures that help treat spinal stenosis are:

Laminectomy

The surgeon removes the back portion, known as lamina, of the impacted vertebra. Laminectomy is often referred to as decompression surgery as it reduces the pressure on the nerves to produce additional space around them.

In certain instances, the vertebra might require linkage to the adjacent vertebrae with a bone graft and metal hardware (spinal fusion). This helps maintain the strength of the spine.

Laminotomy

This surgery entails the removal of only a part of the lamina. This is done through creating a hole just large enough to reduce pressure in a specific area.

Laminoplasty

This surgery is only conducted on the vertebrae in the neck (cervical spine). It creates space in the spinal canal by making a hinge on the lamina. The surgeon uses metal hardware to fill the gap within the opened spinal section.

Minimally Invasive Surgery

This surgery helps remove lamina or bone in a manner that minimizes damage to the surrounding healthy tissue. This leads to a lesser need for fusions. While fusions are an effective way to decrease pain and stabilize the spine, avoiding fusions can mitigate possible complications such as inflammation and pain after the surgery and infection around spinal sections.

A minimally invasive surgery not only reduces the need for fusion but also results in a shorter recovery period. Accomplished orthopedic surgeon Dr. Garabekyan receives patients from North Hollywood, Los Angeles, and other neighborhoods and suburbs in this part of the state for orthopedic surgery and other procedures.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

North Hollywood: 818.755.6500
Century City / Los Angeles: 310.574.0375

Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

A condition related to degeneration of the lower back creating narrowing of the spinal canal or adjacent areas is called spinal stenosis and frequently causes pain in the hip region.

The gradual narrowing of the spinal canal in the spinal column is a degenerative spine condition known as spinal stenosis. This condition typically occurs due to the slow deterioration of the spinal anatomy. It can also happen due to an injury to the back or neck.

While spinal stenosis can happen in individuals from all age groups, it occurs most commonly in people older than 50 years.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery and other treatments to patients in North Hollywood, Los Angeles, and surrounding locations.

Natural Causes

The spinal cord goes from the brain through the spinal canal in a healthy person. Individual nerve roots branch off the cord and extend into the body via canals between the vertebrae. These canals are similar to sheaths and protect the nerves from harm. But these canals can become constricted or clogged over time due to various reasons such as:

• Inflamed soft tissue may encroach on the nerves
• Bone spurs, known as osteophytes, can form
• Discs between the vertebrae can bulge or herniate into the spinal canal
• Vertebrae can become misaligned, known as spondylolisthesis
• Other issues such as infection, disease, tumor, etc.

Routine wear and tear can impact the spinal anatomy causing structures to degrade naturally. Chronic pain and other problems develop as the canals constrict to such a level that they adversely impact the nerves that they are supposed to protect.

Obesity

Surplus body weight puts significant strain on the back, specifically on the lower (lumbar) back. The lumbar spine within the lower back is a magnificent structure.

It enables a person to lean forward and backward, rotate around an axis and supports a majority of the body’s weight. This highlights why lower back issues are so pervasive in healthy people. However, in supporting the excess weight of an obese individual, stenosis and back pain are a foregone conclusion.

Degenerative Conditions

A range of degenerative spinal conditions can lead to spinal stenosis. These conditions include:

• Osteoarthritis: If osteoarthritis impacts the spine, it leads to a slow breakdown of facet joint cartilage. This causes friction between vertebrae and increase in bone spurs.
• Osteoporosis: The slow loss of bone density leads to spondylolisthesis.
• Degenerative Disc Disease: A herniated disc can form if the cartilaginous outer wall of an invertebral disc loses elasticity and water content.
• Osteopetrosis: This is a rare condition that causes the slow enlargement and thickening of bones.

Other Reasons for Spinal Stenosis

Certain individuals are born with a congenital disability that causes a smaller spinal canal to form. Motor accidents and sports injuries can lead to stenosis as well issues such as bulging and herniated discs.

Other causes of spinal stenosis may include:

• Surplus fluoride in the spine
• Spinal tumors
• Paget’s disease that leads to enlarged spinal bones
• Calcified ligaments

Experienced orthopedic surgeon Dr. Garabekyan of SCHI receives patients from North Hollywood, Los Angeles, and nearby areas for orthopedic surgery and other procedures.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

North Hollywood: 818.755.6500
Century City / Los Angeles: 310.574.0375

Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/