Tigran Garabekyan, M.D., Author at Southern California Hip Institute

1658 West Avenue J
Lancaster, CA 93534
Tel: 661-942-6577

Location | Southern California Hip Institute | North Hollywood | Glendale Burbank | Encino | Sherman Oaks | Van Nuys

Error: Contact form not found.

Click here to open LT Reconstruction video.
This video demonstrates treatment of recurrent hip instability in the setting of femoral head bone loss and deficient ligamentum teres (LT). This is an extremely unique and difficult case as there is a lack of bony support in front of the hip to keep the joint stable. Left untreated, the hip is at risk for recurrent dislocations and cartilage injury. The treatment is a minimally invasive outpatient procedure called hip arthroscopy, which is done through two small incisions allowing for an accelerated recovery. As seen in the video, a tissue graft is used to reconstruct the ligamentum teres (LT) to restore stability. Preoperative x-rays and CT scans demonstrate the degree of bony deficiency:

Often, the underlying bony abnormality must also be addressed to restore hip stability. This involves more complex realignment procedures including periacetabular osteotomy (PAO) and/or derotational femoral osteotomy (DFO). Through this holistic approach combining open and arthroscopic treatments, patients can enjoy an active and pain-free lifestyle for many years to come!

Read the full article here.

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. 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 area.

Click here to open Capsular Reconstruction video.
This video demonstrates treatment of recurrent hip instability in the setting of capsular deficiency. This is an extremely unique and difficult case as there is a lack of soft tissue support in front of the hip to keep the joint stable. Left untreated, the hip is at risk for recurrent dislocations and cartilage injury. The treatment is a minimally invasive outpatient procedure called hip arthroscopy, which is done through two small incisions allowing for an accelerated recovery. As seen in the video, a tissue graft is used to reconstruct the lining in front of the hip joint (anterior capsule) to restore stability. MRI scans obtained before and after the procedure demonstrate deficient capsule preoperatively (yellow arrow) and successful healing of the graft (white arrow):

Often, there is an underlying bony abnormality that must also be addressed to restore hip stability. This involves more complex realignment procedures including periacetabular osteotomy (PAO) and/or derotational femoral osteotomy (DFO). Through this holistic approach combining open and arthroscopic treatments, patients can enjoy an active and pain-free lifestyle for many years to come!

Read the full article here.

Click here to open Acetabular Bone Grafting video.
This video demonstrates treatment of painful bone cysts in the hip, which often occur in the setting of hip impingement, hip instability, or osteoarthritis. Left untreated, these cysts can enlarge and erode into the bone that supports the cartilage of the hip joint, causing progressive degeneration. The treatment is a minimally invasive outpatient procedure called hip arthroscopy, which is done through two small incisions allowing for an accelerated recovery. As seen in the video, the cyst is accessed and decompressed using a fiber-optic camera and specialized instruments. The cyst cavity is then filled with bone graft material to promote healing, as shown through the pre- and post-op MRI scans below:

In order to prevent recurrence, the underlying bony abnormality must also be addressed. While hip impingement can be treated arthroscopically during the same bone grafting procedure, hip instability often necessitates more complex realignment procedures such as periacetabular osteotomy (PAO) and/or derotational femoral osteotomy (DFO). Through this holistic approach combining open and arthroscopic treatments, patients can enjoy an active and pain-free lifestyle for many years to come!

Read the full article here.

You’ve probably heard of Ibuprofen, Motrin, Aleve, and Naproxen. What you may not know is that these classes of medication are collectively referred to as non-steroidal anti-inflammatory drugs or NSAIDs. They inhibit an enzyme called cyclooxygenase (COX), whose function is integral to the inflammatory cascade. Inflammation is the body’s way of repairing injured tissues by dilating blood vessels and recruiting new cells to the area of injury. As a result, what you feel is pain warmth, swelling, and redness – often your first indication that an injury has taken place and healing is under way. Think back to any time you physically overexerted yourself or went for a long run without properly warming up or training. You typically don’t feel pain or discomfort until the next day because it takes 12-24 hours for the inflammatory cascade to get under way. The pain you feel is caused not by the injury or overuse, but rather by your body’s response to the injury.

Unfortunately, most people living in today’s world want everything to happen faster and have little patience for letting their bodies acclimate to the sudden shifts in their lifestyle. As a result, they use anti-inflammatory medication to reduce pain and swelling, allowing them to continue the high intensity activities that cause re-injury and progressive damage to their muscles, tendons, and joints. This is not a good use of NSAIDs and can result in the accumulation of significant damage requiring more invasive treatment.

On the other hand, there are instances in which the body’s natural healing mechanism goes unchecked despite rest and activity modification. This can occur when there is a more significant injury and inflammation alone is insufficient to adequately heal the tissues (i.e. hip abductor tear, hamstring tear, labrum tear). These more significant injuries can create a state of chronic inflammation that actually ends up being detrimental. NSAIDs are useful in these circumstances to manage the inflammation that has gone unchecked.

There are countless benefits to leading an active lifestyle. The best way to enjoy these benefits is through a gradual and progressive increase in your participation, using NSAIDs judiciously to overcome chronic inflammation when rest and activity modification alone are insufficient.

Your high school PE teacher knew a lot more than you probably gave her credit for, especially regarding the importance of stretching before physical activity. Apart from being one of the least liked aspects of exercise, stretching has been scientifically proven to confer numerous benefits to muscle and joint health, especially for older adults striving to maintain an active lifestyle. Even young athletes in their prime stand to gain enormous benefit from pre- and post-workout stretches including improved performance and injury prevention.

When muscles and tendons are placed under a gradual and sustained stretch (no bouncies), several physiological phenomena occur that serve to ready the muscle unit for action. Through the activation of β-receptors, arteries providing blood flow to the muscles dilate causing a subtle engorgement, which provides ready oxygen for aerobic consumption. In addition, nerve fibers conveying inhibitory signals to relax the muscle (as a part of a protective mechanism to prevent muscle injury from over-stretching) become conditioned and reduce their inhibitory effect. This enables peak muscle performance without reflexive inhibition at the extremes of stretch. The muscle and tendon unit is now ready to fire on all cylinders and through the full range of motion, giving you peak performance.

There is an added benefit to stretching for older adults who are prone to tendonitis (tendon inflammation) and tendinosis (degeneration of tendons). The hamstring tendons are notorious for overuse injury, especially in January when the “resolutioners” take to the athletic stage for the first time after months of inactivity. With age, the collagen fibers (the braid that makes up the core of the tendon) accumulate microinjury that is imperfectly repaired by the body’s cells. This results in deteriorating tendon quality and a progressive inability to withstand tensile loads (stretch) as well as peak contractile forces (during muscle activation). The poor tendon quality and sudden increase in activity create the perfect storm for partial or full thickness tearing, putting you out of commission. A daily stretching program consisting of 8 – 10 seconds of a gradual and sustained stretch for each muscle group can substantially mitigate the deleterious effects of tendinosis.

Whether you’re a young athlete in your prime or a seasoned veteran who’s not yet ready to give up the sport, all it takes is 5 – 10 minutes a day to keep yourself healthy, strong, and out of the doctor’s office.

Given the increasing popularity of CrossFit, High Intensity Interval Training (HIIT), and Spin Classes, we’d like to take a moment to reflect on the pros and cons of each from an orthopedic perspective.

The musculoskeletal system is both dynamic and biologically active, responding to external loads by building bone density and increasing the size of muscle fibers. Workouts that employ high impact maneuvers performed in rapid sequence (CrossFit and HIIT) are great for building bone density and may reduce the risk of osteoporosis related problems. However, these benefits come at the cost of increased wear and tear on the joints of the body through excessive loading of the surface cartilage in the ankles, knees, and hips.

On the other hand, low impact exercises (Spin) promote joint health by facilitating nutrient uptake in surface cartilage and more even stress distribution. These exercises, however, tend not to build much bone density owing to the low-impact nature of the activities. As such, they do not offer much protection against the age related decrease in bone density, which can lead to osteoporotic fractures.

The best approach, then, is an integrated routine that incorporates both low- and high-impact activities in a balance that can be fine-tuned to your age, body type, and specific goals. A consultation with a fitness specialist can go a long way in helping you design the perfect routine. With discipline and perseverance, you will be on your way to building a healthier body that will serve you well for years to come!

[Youtube_Channel_Gallery feed=”playlist” user=”PL1r1dOrZ-Sq-IVGSoLsTewMiUkMHrAaRJ” player=”1″ cache=”0″ cache_time=”24″ videowidth=”580″ ratio=”16×9″ color=”white” thumb_width=”333″ thumb_ratio=”16×9″ thumb_columns_phones=”2″ thumb_pagination=”0″ thumb_columns_tablets=”3″ thumb_columns_md=”3″ thumb_columns_ld=”3″ title=”1″ key=”AIzaSyA__TTMRUoQdrHkCQgZ9lYZ4OIFmSZ8swc” promotion=”0″ autoplay=”1″]