world class martial arts champion defends title after two acl

World Class Martial Arts Champion Defends Title After Two ACL Surgeries

see page 4

Fall 2013

Getting back to your life.www.c-o-r.com

AlexAndriA • Arlington • Burke • FAir oAkS • FAirFAx • Herndon • reSton • SpringField • tySonS Corner

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The Total Joint Center at Reston Hospital Center has exactly what you need

to relieve the pain in your joints. Expertise. Our center has been awarded

the gold seal of approval from the Joint Commission for excellence in joint

replacement. Founded on the collective experience of fellowship-trained

doctors, physical therapists, case managers and nurses, the Total Joint

Center at Reston Hospital Center can get you back to living your life.

RESTON HOSPITAL CENTER / DOMINION HOSPITAL / STONESPRING EMERGENCY CENTER

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GOODBYE JOINT PAIN / HELLO LIFE.

President’s Column

Contents

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President Gordon L. Avery, MD

Chief Executive Officer William L. Harvey

Chief Operating Officer Maureen M.R. Cook

Chief Financial Officer Richard T. Givens

Director of Physical Therapy Jo-Anne Burton, DPT

Director of Human Resources Michelle Melito

Directors of Marketing Suzanne M. Kelly

Deborah R. Martin

Editorial Mission: Commonwealth Orthopaedics magazine is an educational and informative resource for physicians, health care professionals, employer groups, and the general public. This publication provides a forum for communicating news and trends involving orthopaedic-related diseases, injuries, and treatments, as well as other health-related topics of interest.

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Medical

Going for the Gold .....................................................................4

A Healing Hand ...........................................................................6

Specialized Therapy for Tendon Injuries .................................7

An Exciting New Treatment Option for Chronic Tendonitis ...............................................................9

Back in the Swim ...................................................................... 10

Employee Spotlight: A Happy Home for 23 Years ............. 13

Improving the Patient Experience ........................................ 13

Good For Another 60,000 Miles .......................................... 14

2012 Report to the Community .......................................... 16

Teaming Up to Improve Community Health ..................... 18

Reversing the Damage ............................................................ 22

Double Trouble ......................................................................... 24

All in the Family ........................................................................ 26

On the cover:

Nikki, the reigning martial

arts champion, returned to

her sport after having two

ACL reconstructions.

See page 4.

Welcome to the Fall 2013 issue of Commonwealth Orthopaedics Magazine. This is an exciting season for us at Commonwealth Orthopaedics. We are preparing to open our newly renovated and expanded Outpatient Surgery Center in Herndon. And we are celebrating our second year as the official orthopaedic and physical therapy partner of the Washington Redskins.

This issue of the magazine includes our 2012 annual report. As you’ll see, we continue to add new services, new locations and new orthopaedic specialists to better serve patients throughout the region. Patient volumes are up and our patient satisfaction scores remain strong. We are proud that a vast majority of our customers would recommend our physicians and services to a friend or loved one.

But don’t just take our word for it! Read the compelling stories of some of our most satisfied patients: a world-class martial arts champion who battled back from two ACL surgeries to win gold; tennis partners who captured their club’s doubles championship following rotator cuff repairs; a grandmother back at work after a unique shoulder replacement procedure; and a young college student’s hard-fought recovery from extensor tendon repair.

The world of orthopaedic medicine is changing daily and Commonwealth remains at the forefront, offering the latest surgical procedures and therapies. Learn about the newest options in total hip replacement, advanced elbow arthroscopy and a state-of-the-art treatment for chronic tendonitis.

As always, we appreciate the opportunity to provide this level of excellence to you and your patients, and we are grateful for your ongoing support.

Sincerely,

Gordon L. Avery, MD President Commonwealth Orthopaedics

The Total Joint Center at Reston Hospital Center has exactly what you need

to relieve the pain in your joints. Expertise. Our center has been awarded

the gold seal of approval from the Joint Commission for excellence in joint

replacement. Founded on the collective experience of fellowship-trained

doctors, physical therapists, case managers and nurses, the Total Joint

Center at Reston Hospital Center can get you back to living your life.

RESTON HOSPITAL CENTER / DOMINION HOSPITAL / STONESPRING EMERGENCY CENTER

FIND A PHYSICIAN AT 877-689-DOCS (3627) OR RESTONHOSPITAL.COM.

GOODBYE JOINT PAIN / HELLO LIFE.

4 Commonwealth Orthopaedics | www.c-o-r.com

going for the goldWorld-Class Martial Arts Champ Returns from Two ACL Reconstructions to Defend Title

As the world’s reigning martial arts champion, Nikki is accustomed to hard fights and grueling physical competition. So when she injured her knee while sparring

at the 2012 World Martial Arts Games in England, she was not deterred. “My coaches wrapped up my leg and made me finish,” says the 27-year-old from Culpepper. “An hour later, I had to compete again. Everyone watching knew what had happened. I got a standing ovation. The mayor took pictures.”

Nikki boarded her flight back to Washington with two gold medals, a world championship ring and one torn anterior cruciate ligament (ACL) in her right knee. As soon as the plane took off, she knew who to call: George Aguiar, MD, at Commonwealth Orthopaedics. One year earlier, he had performed ACL reconstruction on her left knee and supervised her return to global competition.

This time, her comeback goal was even more ambitious: to be ready to compete in the Caribbean Sunrise Showdown Battle of the Arts in Trinidad and Tobago within eight months. Dr. Aguiar performed ACL reconstruction on her right knee and Nikki spent

several months in what she calls rehabilitation “boot camp”– intense cardio and strengthening focused on returning her to top physical condition.

“Nikki is an exceptional patient,” Dr. Aguiar says. “After both her surgeries, we outlined a careful rehabilitation program and she was highly motivated and extremely diligent with her exercises. The timing to return her to competition was very individualized. Numerous assessments and tests were required prior to clearing her for sports.”

ACL tears are one of the most common knee ligament injuries. Athletes who play sports that involve running, pivoting, turning and jumping are especially susceptible. They may feel a slip or pop in their knee and the knee gives out from under them.

“ACL tears are often the result of plain bad luck and there’s not a lot that people can do to prevent them,” says Commonwealth surgeon Bruce Zimmer, MD. “They happen to everyone – even pro athletes in great shape, like Redskins quarterback Robert Griffin, III. It all has to do with the force and angle at which the knee gets hit.”

George Aguiar, MD, graduated with a BS in Biology from Georgetown University in Washington, DC, and then continued his education at the Georgetown University School of Medicine where he earned his medical degree and completed his surgical internship and orthopaedic

residency. Dr. Aguiar was named to the Alpha Omega Alpha Honor Society.

Bruce S. Zimmer, MD, graduated magna cum laude with a BS from Virginia Commonwealth University in Richmond, Virginia, and then earned his medical degree from the Medical College of Virginia. He stayed on at the Medical College of Virginia to complete both his surgical

internship and orthopaedic residency.

For full biographies and a complete directory of the physicians at Commonwealth Orthopaedics who perform these and other procedures visit our website at www.c-o-r.com.

Commonwealth Orthopaedics | www.c-o-r.com 5

Symptoms include knee swelling, pain and stiffness, limited range of motion and tenderness along the joint line. Treatment varies depending on a patient’s age, function and activity level. “For those individuals who are stable, with little desire to return to high-level sports or fitness routines, we often recommend non-operative rehabilitation,” Dr. Aguiar explains. “We see many patients over 50 with ACL tears who are very stable after rehab and can avoid surgery entirely.”

ACL reconstruction can return patients such as Nikki to high-level intensity, but again, proper rehabilitation is critical. Athletes who resume cutting and pivoting sports too soon risk re-injury. Dr. Aguiar notes that one great challenge is slowing down high-level athletes. “Although many can progress quickly, the key is proper assessment to determine if they are truly ready for the next phase of recovery,” he says. Communicating the goals for recovery to the patient is vital to ensure an excellent, long-term outcome.

“We usually recommend patients wait from eight to 12 months before returning to aggressive contact sports,” says Dr. Zimmer. “The time is important for the vascular structure to strengthen and the graft to get strong. If patients feel good four to five months out, they can jog. But for anything involving contact, it’s better to wait a few more months.”

Nikki’s hard work paid off. She was able to compete in – and win – the Sunrise Caribbean Showdown. One month later, she successfully defended her international title at the 2013 World Martial Arts Games in Dublin. But she heeded Dr. Aguiar’s advice and limited her matches to forms (also known as Kata) only. “I don’t want to take any chances, so I’m waiting to return to competitive fighting until the end of the year,” she says. In Ireland, she was inducted into the World Organization of Martial Arts Athletes International Hall of Fame as International Female Instructor of the Year. She is now back in the classroom, teaching earth science at Kettle Run High School in Nokesville and coaching martial arts students at her family’s Karate Sports Academy in Warrenton.

She loves Dr. Aguiar’s no-nonsense approach, and routinely recommends him to family and friends. “His work is superb and, as long as you listen to his advice, you’ll get back to your game,” she says. “It’s come to the point now that if someone I know gets injured, I send them to him – no matter what body part it is.”

Nikki was recently inducted into the World Organization of Martial Arts Athletes International Hall of Fame as International Female Instructor of the Year!

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A Healing HandTreatment and Rehabilitation of Extensor Tendon Injuries

6 Commonwealth Orthopaedics | www.c-o-r.com6 Commonwealth Orthopaedics | www.c-o-r.com

After severing the extensor tendons of her index and middle fingers, Brittany had surgery to repair the lacerated tendons and is now able to enjoy the simple joys in her life, like taking care of her dog, Jack.

What types of tendon injuries do you see?

Tendon injuries can be isolated, such as a laceration from a knife; or in tandem with other traumas, like fractures and nerve lacerations. Some tendon injuries are the result of a cut, so there is an open wound. Others are called avulsions, when a finger is wrenched aggressively, and the tendon pulls out of the bone, but there is no bleeding or skin tear.

What is involved in therapy?

Therapy addresses all aspects of the injury: wound care, pain management, caring for the healing scar, motion recovery and, most importantly, restoring function to the hand.

What is the goal?

The goal of rehabilitation is to maximize the post-operative recovery, give the patient the best outcome possible, restore hand use and promote a return to independence: self care, work, leisure activities and activities of daily living.

Why is therapy so important for these patients?

Therapy for tendon injuries is very specialized. There is a delicate balance between controlled stress to strengthen the healing tissues, and proper positioning and rest to protect the repair. Too much motion can cause the repair to rupture; too little and scar adhesions develop and the tendon won’t function properly.

How does Commonwealth excel in this area?

Strong communication between surgeon and therapist is of vital importance. At Commonwealth, we have three certified hand therapists (CHTs) on staff who are in constant contact with our four hand surgeons. Because the surgeons and CHTs are all in-house, it promotes easy access. It’s not unusual for a surgeon to call one of us from the operating room to update us on a patient and initiate a treatment plan.

Katie Canestrano, OTR/L, CHT. Katie graduated summa cum laude from Lenoir Rhyne University in 2000. She began her career in the DC metro area in outpatient occupational therapy, and decided early on to focus on hand rehabilitation. She received her certification in hand therapy after meeting all of the

commission’s criteria in 2006.

Specialized Therapy for Tendon InjuriesA conversation with Katie Canestrano, OTR/L, Certified Hand TherapistThe freak accident happened in seconds: a glass

lampshade shattered, sending a shard into Brittany’s right hand and severing the extensor

tendons of her index and middle fingers. “I was think-ing I should be able to move them! But even though I consciously tried, my fingers remained limp and mo-tionless,” recalls the 22-year-old theology student. Ev-erything she took for granted – walking the dog, cook-ing, texting her boyfriend – was suddenly in jeopardy.

An ambulance took Brittany to Virginia Hospital Center where she was referred to hand surgeon Sarah Pettrone, MD, at Commonwealth Orthopaedics. A week later, Dr. Pettrone performed an intricate procedure to repair Brittany’s lacerated tendons at Commonwealth’s Outpatient Surgery Center in Herndon.

Then the hard part really began. Brittany spent the next three months working with a certified hand thera-pist (CHT) to restore function, motion and strength to her right hand. “Simple exercises were much more challenging than I'd expected and required a lot of pa-tience. Everything seemed to take three times longer!” she says. “It really opened my eyes. Who thinks about their tendons when they move their hands? “

Extensor tendons are bands of tissue that originate from muscles located on the back of the forearm, hand and fingers. They are responsible for straightening the wrist, fingers and thumb. “Extensor tendons are most commonly injured when the finger is jammed or from a cut that goes through the skin,” says Commonwealth hand surgeon Frederick Scott, MD. “Injuries in which the finger is jammed usually respond to splinting until the tendon is healed. Tendon injuries from cuts may require repair with stitching the ends together, in addi-tion to splinting.”

Extensor tendon injuries pose unique challenges for treatment. The extensor mechanisms are in a superfi-cial position, not enclosed in tendon sheaths, and tend to be thinner and flatter than flexor tendons (the ten-dons on the palm side that bend the fingers). Surgical repairs for lacerations such as Brittany’s also pose chal-lenges post-operatively, as Dr. Pettrone explains. “The difficulty with these injuries is that the repair is weak, being held together by thin sutures only, until the ten-don heals by about six weeks. We can't simply immobi-lize the finger because too much scar tissue will form and it will be hard for the patient to regain motion. So


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Sarah Pettrone, MD, graduated summa cum laude from the University of Notre Dame with a BS in Biology. Dr. Pettrone earned her medical degree from the University of Virginia School of Medicine in Charlottesville, Virginia. While there, she was selected as a Bowman Scholar. Following medical school, Dr.

Pettrone completed an orthopaedic surgery internship and residency at New York University-Hospital for Joint Diseases as well as a hand fellowship at the University of Washington in Seattle.

Frederick D. Scott, Jr., MD, earned a BS in Chemical Engineering and Biochemistry from the University of Maryland-Baltimore County and received his medical degree from the University of Maryland School of Medicine. Following two years in general surgery at the University of Maryland Medical Center, he spent a

year performing research in the university’s Department of Orthopaedics. He went on to an orthopaedic residency at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson and then completed a hand and microvascular fellowship at the Hand and Shoulder Center of Western New York at SUNY-Buffalo.


therapy becomes a critical part of the treatment for a tendon injury.”

Commonwealth has three dedicated CHTs to treat these types of injuries. With newer, active range-of-motion therapy pro-tocols, patients have better outcomes and can return to full function. (See sidebar on page 7.)

Thanks to Brittany’s determination and commitment to her rehabilitation, she regained all of her motion and strength. She’s back to her active lifestyle, which includes completing her BA in Biblical Studies at Louisiana Baptist University, teaching online college courses and playing the keyboard. She is grateful to the entire Commonwealth staff for easing her fears about first-time surgery and credits Dr. Pettrone’s knowl-edge and skill for a successful outcome that has impacted the rest of her life. She doesn’t hesitate to recommend Common-wealth to family and friends.

“I love the common joys in life and it was a little sobering to think I might not be able to do these things again,” she says. “I owe my heartfelt thanks to Dr. Pettrone and everyone at Commonwealth Orthopaedics!”


What is the FAST™ Technique?FAST, which stands for fasciotomy and surgical tenotomy, is a new, non-operative, FDA-approved treatment option for patients with chronic tendinopathies. At Commonwealth, we’ve used this technique to successfully treat patients with tennis elbow and golfer’s elbow, as well as tendonitis in the kneecap, rotator cuff and Achilles tendon.

Who is a good candidate for the FAST procedure?Anyone who has had tendonitis for more than three months is a good candidate. In addition, anyone who has failed more conservative measures such as therapy or cortisone injections for their tendonitis symptoms should consider the procedure.

How does FAST work?The procedure uses ultrasound waves inserted through a small incision in the skin to identify and break up calcification and chronic tendonosis. It is quick and minimally invasive and provides patients an effective treatment option without an open surgical procedure.

How many treatments are involved? Just one. FAST is a permanent fix that successfully removes pain-generating soft tissue.

What are the benefits?The entire procedure takes only about 30 minutes. It is performed under local anesthesia, which means the patient remains completely awake throughout. The incision is tiny – just 3 mm, which

is about one-eighth of an inch. All of this makes recovery fast and easy.

What is involved in the recovery process? Recovery time is minimal and most people can return to work the following day. Exercise can be resumed in one to two weeks in most cases.

What are the outcomes? At Commonwealth, our patient outcomes have been excellent. A vast majority of patients see a significant improvement right away in their tendonitis, with no recurrence of symptoms.

Where is the procedure performed?Currently, FAST is performed at Commonwealth’s Outpatient Surgery Center. In the future, we hope to offer this option in the office.

Do patients come for an office visit before scheduling the procedure? Do they need a referral? We do have patients come for an office visit first. If the assessment determines that FAST is an appropriate treatment option, we go ahead and schedule the procedure at the outpatient surgery center. Patients do not need special referrals for either the office visit or FAST procedure unless required by their insurance plan.

Is FAST covered by insurance?The FAST procedure is FDA-approved, so it is covered under most insurance plans. However, it is considered an outpatient

procedure and some insurance plans may require a co-pay. Patients should check with their insurance companies for specifics.

Dr. Trucksess is the only physician at Commonwealth Orthopaedics who performs the FAST™ Technique and one of the only physicians in Northern Virginia to offer this innovative option. If you have questions about FAST, call Melissa Bryon at 703-810-5202 ext. 1426.

An Exciting New Treatment Option for Chronic Tendonitis

Amanda Trucksess, MD, Discusses the Tenex FAST™ Technique

Amanda B. Trucksess, MD, graduated cum laude from the College of William and Mary with a major in kinesiology. She went on to earn her medical degree

from the Virginia Commonwealth University School of Medicine at the Medical College of Virginia. Dr. Trucksess completed a four year residency in Physical Medicine and Rehabilitation at the University of Virginia.


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What is the FAST™ Technique?

FAST, which stands for fasciotomy and surgical tenotomy, is a new, non-operative, FDA-approved treatment option for patients with chronic tendinopathies. At Commonwealth, we’ve used this technique to successfully treat patients with tennis elbow and golfer’s elbow, as well as tendonitis in the kneecap, rotator cuff and Achilles tendon.

Who is a good candidate for the FAST procedure?

Anyone who has had tendonitis for more than three months is a good candidate. In addition, anyone who has failed more conservative measures such as therapy or cortisone injections for their tendonitis symptoms should consider the procedure.

How does FAST work?

The procedure uses ultrasound waves inserted through a small incision in the skin to identify and break up calcification and chronic tendonosis. It is quick and minimally invasive and provides patients an effective treatment option without an open surgical procedure.

How many treatments are involved?

Just one. FAST is a permanent fix that successfully removes pain-generating soft tissue.

What are the benefits?

The entire procedure takes only about 15 minutes. It is performed under local anesthesia, which means the patient remains completely awake throughout. The incision is tiny – just 3 mm, which


What is involved in the recovery process?

Recovery time is minimal and most people can return to work the following day. Exercise can be resumed in one to two weeks in most cases.

What are the outcomes?

At Commonwealth, our patient outcomes have been excellent. A vast majority of patients see a significant improvement right away in their tendonitis, with no recurrence of symptoms.

Where is the procedure performed?

Currently, FAST is performed at Commonwealth’s Outpatient Surgery Center. In the future, we hope to offer this option in the office.

Do patients come for an office visit before scheduling the procedure? Do they need a referral?

We do have patients come for an office visit first. If the assessment determines that FAST is an appropriate treatment option, we go ahead and schedule the procedure at the outpatient surgery center. Patients do not need special referrals for either the office visit or FAST procedure unless required by their insurance plan.

Is FAST covered by insurance?

The FAST procedure is FDA-approved, so it is covered under most insurance plans. However, it is considered an outpatient


Dr. Trucksess is the only surgeon at Commonwealth Orthopaedics who performs the FAST™ Technique and one of the only physicians in Northern Virginia to offer this innovative option. If you have questions about FAST, call Melissa Bryon at 703-810-5202 ext. 1426.










What is the FAST™ Technique?FAST, which stands for fasciotomy and surgical tenotomy, is a new, non-operative, FDA-approved treatment option for patients with chronic tendinopathies. At Commonwealth, we’ve used this technique to successfully treat patients with tennis elbow and golfer’s elbow, as well as tendonitis in the kneecap, rotator cuff and Achilles tendon.

Who is a good candidate for the FAST procedure?Anyone who has had tendonitis for more than three months is a good candidate. In addition, anyone who has failed more conservative measures such as therapy or cortisone injections for their tendonitis symptoms should consider the procedure.

How does FAST work?The procedure uses ultrasound waves inserted through a small incision in the skin to identify and break up calcification and chronic tendonosis. It is quick and minimally invasive and provides patients an effective treatment option without an open surgical procedure.

How many treatments are involved? Just one. FAST is a permanent fix that successfully removes pain-generating soft tissue.

What are the benefits?The entire procedure takes only about 30 minutes. It is performed under local anesthesia, which means the patient remains completely awake throughout. The incision is tiny – just 3 mm, which


What is involved in the recovery process? Recovery time is minimal and most people can return to work the following day. Exercise can be resumed in one to two weeks in most cases.

What are the outcomes? At Commonwealth, our patient outcomes have been excellent. A vast majority of patients see a significant improvement right away in their tendonitis, with no recurrence of symptoms.

Where is the procedure performed?Currently, FAST is performed at Commonwealth’s Outpatient Surgery Center. In the future, we hope to offer this option in the office.

Do patients come for an office visit before scheduling the procedure? Do they need a referral? We do have patients come for an office visit first. If the assessment determines that FAST is an appropriate treatment option, we go ahead and schedule the procedure at the outpatient surgery center. Patients do not need special referrals for either the office visit or FAST procedure unless required by their insurance plan.

Is FAST covered by insurance?The FAST procedure is FDA-approved, so it is covered under most insurance plans. However, it is considered an outpatient


Dr. Trucksess is the only physician at Commonwealth Orthopaedics who performs the FAST™ Technique and one of the only physicians in Northern Virginia to offer this innovative option. If you have questions about FAST, call Melissa Bryon at 703-810-5202 ext. 1426.










CWOrtho-Fall2013-r05.indd 9 10/11/13 12:49 PM

Back in the Swim

Chuck has a dream: to swim around the world. Not literally, of course, but lap-by-lap in his local pool. Years of competitive swimming in high school, college and

beyond have added up. Swimming approximately 2.5 miles per

day, five days a week, he figures it will take him another 10 years

to reach his goal.

His dream was nearly derailed by a combination of issues in his

right elbow. They included arthritis, bone spurs, and a piece of

loose cartilage and bone (called a loose body), which caused his

elbow to catch and lock while he was swimming or playing golf.

He had to use his left hand to do simple, everyday activities such

as buttoning a shirt, shaving or combing his hair.

With increasing pain and decreasing range of motion, Chuck, 53, sought a solution that would get him back in the pool and onto the golf course as quickly and efficiently as possible. “I wanted to avoid traditional, open surgery and a long recovery time,” he says. “But all the doctors I talked to said my combination of problems would make minimally invasive surgery too difficult.”

Chuck found what he was looking for when his primary doctor referred him to hand surgeon Peter Thomas, MD, at Commonwealth Orthopaedics. Dr. Thomas was the first physician Chuck encountered who agreed to give elbow arthroscopy a try. In this minimally invasive approach, the surgeon uses a small video camera and tiny instruments to inspect, diagnose and repair problems inside the joint. “We use this technique increasingly


After minimally invasive elbow surgery, Chuck continues to work on his goal of swimming around the world.

Complex Elbow Arthroscopy Helps Local Athlete Pursue His Dream

After minimally invasive elbow surgery, Chuck continues to work on his goal of swimming around the world.

Following physical therapy after his elbow arthroscopy surgery, Chuck is back to swimming five days a week at Springhill Rec Center in Tysons.

to perform complex procedures that previously had to be done through large incisions on either the side or back of the elbow,” Dr. Thomas says. “Specific indications include removal of loose bone and articular cartilage in early arthritis, excision of joint-lining tissue in early arthritis, an all-internal approach to tennis elbow surgery that improves post-operative recovery and arthroscopic repair of small joint fractures.”

Performing minimally invasive procedures in the elbow has two big advantages, as Commonwealth hand and upper extremity surgeon Alexander Croog, MD, explains: “There is less trauma during surgery to the muscles and tissue that envelop the elbow and a faster post-operative recovery. Faster recovery means earlier range of motion, thereby preventing scarring and contracture of the elbow, which is a common problem in elbow surgery.”

The role of elbow arthroscopy in the treatment of elbow disorders has been dramatically increasing over the past few years. As Dr. Croog notes, it used to be that it was used only to remove loose bodies from arthritis. Now surgeons perform the technique to treat more than a dozen complex elbow conditions, including trauma, cartilage injuries, contracture, stiffness, tendonitis and problems experienced by the throwing athlete. Still, the procedure is in its relative infancy compared to arthroscopy of the shoulder

and knee, which are widespread and have been around much longer. And because the elbow is such a complex joint, surgical experience and training are critical to a good outcome. “In no other joint is the margin of error smaller, because of the close proximity of important nerves and blood vessels,” Dr. Croog says. “Therefore, it is important to have a surgeon specifically trained who knows the structural anatomy of the elbow well.”

Although arthroscopy does not cure arthritis of the elbow, patients such as Chuck can enjoy significant improvement in symptoms and function. Dr. Thomas explains that arthroscopy to extend the life of the elbow is preferable to elbow replacement surgery, which is still prone to complications and not indicated in young, active patients with other alternatives.

Immediately following his outpatient procedure, Chuck began physical therapy to stretch out the tendons and ligaments in his right arm and build back strength and range of motion. He is now swimming again, pursuing his round-the-world goal. Surgery and rehab kept him out of the water for about six weeks, so he’s making it up by swimming a few extra laps per day. His golf game has also drastically improved and he’s started to regain his mid to low single-digit handicap.


12 Commonwealth Orthopaedics | www.c-o-r.com12 Commonwealth Orthopaedics | www.c-o-r.com

Alexander S. Croog, MD, earned a BA in Psychology from Harvard University before studying medicine at the University of Virginia School of Medicine. There,

he was named to the Alpha Omega Alpha honor society. Dr. Croog completed his residency in orthopaedic surgery at New York University/Hospital for Joint Diseases in New York City under the leadership of Dr.

Joseph Zuckerman.

Peter R. Thomas, MD, earned a BA in Biology from Johns Hopkins University and a Masters in Applied Molecular Biology from

the University of Maryland. Dr. Thomas received his medical degree from the Pennsylvania State University School of Medicine. He went on to an orthopaedic surgery residency at Union Memorial Hospital in Baltimore, where he also completed a fellowship in hand surgery at the hospital’s Curtis National Hand Center. His training includes visiting fellow in the Medical Device Fellowship Program at the Food and Drug Administration’s Center for Devices and Radiologic Health.


“The surgery made such a big difference to my quality of life and allowed me to quickly return to the activities I enjoy,” he says. “Now, I can swim and swing the golf club without worrying about the damage or intense pain of my elbow jamming on me. Dr. Thomas listened to all my concerns and was willing to perform the minimally invasive procedure that I wanted. Everything is working well and I couldn’t be happier with the outcome.”

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Honeymooning in Alaska, where no one could reach her, Karen Newell was blissfully unaware she’d lost her job. When she and her husband returned from

their trip, she learned the medical equipment company she worked for had gone out of business. It proved to be a lucky break. If she hadn’t lost her job on her honeymoon, she never would have found Commonwealth Orthopaedics.

Karen has been with the practice from the beginning. She was originally hired by Thomas Walker, MD, back in 1990, as a medical secretary for a small physician office in Reston. Four years later, that practice merged with a practice in Herndon and Commonwealth officially opened its doors.

Karen has spent the last 23 years working at the Reston office, most recently as medical secretary for surgeons Thomas Klein, MD and Andrew Parker, MD. Her job included scheduling patient appointments and surgery, resolving insurance issues, answering billing questions, and directing patients to the appropriate resource, physician or office location. In July, she transferred to Commonwealth’s new Centralized Scheduling Center, where she is using her expertise to train staff in the nuances of patient scheduling and other administrative tasks.

For this self-proclaimed people person, working at the call center will give her more of what she likes most: patient contact. “I really love dealing with people – trying to help them and make them happy – so this is a perfect fit for me,” she says.

She enjoys trying to figure things out and her many years of experience make her a great resource for Commonwealth staff and patients alike.

Patients turn to her to take care of paperwork and insurance issues prior to surgery. “It’s very satisfying to be able to ease the process for them and handle all of the administrative details so they don’t have to worry about those things,” she says.

When she’s not at work, Karen enjoys biking, hiking and traveling. She and her husband recently celebrated a milestone moment when their oldest son departed the family home in South Riding to start college in California.

Commonwealth has been her happy work home for 23 years. “I love the doctors, the patients and everyone I work with – they really are my second family,” she says. “I love coming to work here every day.”


Employee Spotlight:A Happy Home for 23 Years

Karen Newell has been assisting Commonwealth Orthopaedic patients for 23 years.

We are consolidating our popular outpatient surgery centers to provide more efficient care for patients. Our Herndon center, located in the Franklin Farm

shopping center, is temporarily closed for construction to add a fourth operating room. The physician office on the second floor is also being renovated to better support our foot and ankle services at that location. When the Herndon center reopens later this fall, we will permanently close the surgery center in Fairfax.

“It’s more efficient for us to provide comprehensive surgical services in a single location with four rooms, instead of two locations with three rooms each,” explains Maureen Cook, Chief Operating Officer. “This will help us meet growing demand most effectively.”

The surgery center provides scheduled and urgent outpatient orthopaedic surgery, pain management and anesthesia services for Commonwealth patients. The state-of-the-art facility is accredited by

the Accreditation Association for Ambulatory Health Care. It offers patients many advantages over a hospital setting, including:

• Comfort and convenience

• Fewer delays

• Dedicated and experienced clinical staff solely focused on orthopaedics

• Customized anesthesia and pain management options

• Lower infection risk

• Faster recovery

“Patients love the warm, friendly setting and the personalized care they receive at the surgery center,” says Janet Ward, Director of Surgical Services. “Patient satisfaction scores are consistently high, with more than 98% of our patients rating their experience as very good to excellent.”

Outpatient Surgery Center Consolidation to Improve the Patient Experience


More than 40 years in the construction business had taken its toll on Ralph. Painful osteoarthritis in his hips made it increasingly difficult for the 65-year-old from Spring-

field to perform everyday activities. Although he knew he’d eventu-ally need hip replacement, he wanted to wait until after he retired. To buy some time, Commonwealth surgeon Daniel Thompson, MD, recommended that Ralph try non-operative options, including anti-inflammatory medications and cortisone injections. “Dr. Thomp-son was very understanding and never pushed me toward surgery,” Ralph says. “He told me, ‘when it hurts enough, you’ll do it.’”

In early 2011, Ralph decided that it hurt enough. He had his first hip replacement with Dr. Thompson in March. It went so well, he had his second procedure just seven weeks later.

Advancements in hip replacement surgery are offering new options for younger patients such as Ralph. Better, longer-lasting materials are one big difference, as Dr. Thompson explains. “The polyethylene has become far more technical—irradiated, quenched of free radi-cals, some even doped with other agents such as vitamin E. This can dramatically increase longevity by decreasing wear. Other options that have been developed and improved over the past several years include use of metal-on-metal or ceramic-on-ceramic articulations – even diamond articulations – and combinations of all of these.” Dr. Thompson points out that each has its pros and cons, so it’s im-portant that the surgeon determine what is best for an individual patient.

Technical aspects have also changed for the better. One cutting-edge technique is direct anterior total hip replacement, in which surgeons approach the hip from the front, rather than the back or side. “In this method, muscles are split, rather than cut and reattached, which leaves those most important for hip function – the gluteus muscles that attach to the pelvis and femur – undisturbed,” explains Mark McMahon, MD, a Commonwealth surgeon who is among a hand-ful of local physicians who perform this type of hip replacement on a regular basis. “The anterior approach is far less traumatic for patients, with a very small incision, so pain is minimized and the risk of dislocation reduced. Because muscles aren’t cut, patients are stronger afterward and recover function much more quickly. They can put weight on the hip immediately.”

Other technical innovations include computer-assisted surgery, which uses pre-op templates and intra-op navigational guides for placement and positioning of the prosthesis, and customized, pa-tient-specific implants that result in a more exact fit and better wear

resistance over time.

Pre-operative medications and anesthesia are other big improve-ments that help with rapid recovery. “Frequently, regional anesthe-sia such as an epidural is used to minimize the anesthetic needed, as well as reduce the blood loss of surgery,” Dr. Thompson says. “This allows almost all patients to get up and walk on the same day of surgery. Most are ready for discharge from the hospital two days after surgery, and many are walking without aids within a couple of weeks.”

Following his surgeries, Ralph spent time working with one of Commonwealth’s physical therapists to regain range of motion and strengthen the muscles in his hips. When he finished therapy, he resumed walking on a treadmill and lifting weights. He’s now walk-ing 2.5 pain-free miles on the treadmill every day. “Dr. Thompson did an excellent job,” Ralph says. “At my one-year checkup, he told me I’m good for another 60,000 miles. My new hips should last 25 or 30 more years.”

Ralph is the perfect example of a young, healthy, active man who decided not to suffer anymore and go ahead with replacement, notes Dr. Thompson, who has this advice for others in similar circum-stances: “When the pain of hip arthritis is bad enough to impact dai-ly life and prevent you from doing your activities, it’s definitely time to seriously consider improving your life with a hip replacement op-eration. It’s not without risk, but the benefits far exceed those risks.”

Good for Another 60,000 MilesAdvancements in Hip Replacement Offer New Options for Younger Patients

Mark R. McMahon, MD, earned a BA from the University of Oregon and his medical degree from Oregon Health Sciences University. He completed a general surgery internship from the University of Oregon and orthopaedic residency from the University of Southern California.

Daniel E. Thompson, MD, earned a BS in Biomechanical Engineering from Stanford University and then earned his medical degree from the University of Mississippi School of Medicine in Jackson. He completed both his general surgery internship and orthopaedic residency at Georgetown

University Medical Center.


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2012 Report to the Community

Patient SatisfactionOver 6,700 patients completed a patient satisfaction survey in 2012. Of those surveyed, the following percentage of patients indicated that they would recommend Commonwealth Orthopaedics to a friend/family member:

Physician office patients

Outpatient surgery center patients

Physical therapy patients

95.3%

98.6%

99.9%

Physical Therapy Visits – 80,745

Total Procedures – 14,888

Total Arthroscopies – 6,965

Children & Adolescents

0 3,000 6,000 9,000 12,000

Fracture Care 1,017

Surgeries 677

Fracture Care Surgical 264

Consults 503

cover story:Healthy PartnershipThe Washington Redskins Charitable Foundation, Commonwealth Orthopaedics, DePuy Mitek, Inc., and Safe Kids Coalition teamed up to educate more than 120 Sterling Middle School students on injury prevention, physical fitness and concussion safety at the Redskins Play 60 Mini-Combine at Redskins Park.

Several Redskins players attended the event to help teach students how to eat right and live a healthy lifestyle. Commonwealth Orthopaedics’ physicians and physical therapists demonstrated warm up and stretching exercises and discussed sports injuries and prevention tips.

In 2012, Commonwealth Orthopaedics and the Washington Redskins formed a four-year partnership. As the team’s Official Orthopaedic and Physical Therapy Partner, we are working together to promote community health and wellness initiatives and achieve the goal of making Redskins fans the healthiest in the NFL. Commonwealth has a dedicated page on Redskins.com that includes health and wellness information on a variety of orthopaedic topics: http://www.redskinshealthandwellness.com/ask-experts/.

Total Patient Visits – 181,708

Arthroscopies6,965

Other2,730

Spine1,334

Arthroscopies6,965

Total Joint1,723

Hand1,076

Shoulder700Foot and

Ankle360

Knee3,423

Shoulder1,182

Bankart233Menisical

Repair232

Other97

ACL734

Ankle, Elbow and Wrist

297

Hip767 Arlington

13,232

Fairfax14,881

Reston14,544

Fair Oaks1,872

(opened 11/1/12)

Herndon13,201

Tysons11,415

Springfield11,600

In 2012, Commonwealth Orthopaedics

welcomed three new physicians:(pictured left to right)

Frederick D. Scott, Jr., MDSpecializing in hand and upper extremity

Peter R. Thomas, MDSpecializing in hand and upper extremity

Anthony L. Avery, MDSpecializing in sports medicine

Visit our website at www.c-o-r.com to read their complete bios.

Established124,529

New32,463

Pediatrics18,082

Consults6,634

Fracture Care

Established Patients 12, 767

Surgical 1,696

Non-surgical 2,380

Total Surgical and Non-surgical 4,076

Surgery Cases at Commonwealth Outpatient Surgery Centers

2,476

2,002

Total number of cases 4,478

New Patients 4,812

Pain Management/Physiatry Appointments 3,735

PA Visits – 26,781

Life is good and I’m loving every minute of it. I’m very

pleased with the results of all my surgeries. I tell everybody – if you

have problems just get it done.LeRoy – Falls Church

Multiple Joint Replacements

photo: jose argueta

Healthy PartnershipThe Washington Redskins Charitable Foundation, Commonwealth Orthopaedics, DePuy Mitek, Inc., and Safe Kids Coalition teamed up to educate more than 120 Sterling Middle School students on injury prevention, physical fitness and concussion safety at the Redskins Play 60 Mini-Combine at Redskins Park.


In 2012, Commonwealth Orthopaedics and the Washington Redskins formed a four-year partnership. As the team’s Official Orthopaedic and Physical Therapy Partner, we are working together to promote community health and wellness initiatives and achieve the goal of making Redskins fans the healthiest in the NFL. Commonwealth has a dedicated page on Redskins.com that includes health and wellness information on a variety of orthopaedic topics: www.redskinshealthandwellness.com/ask-experts

CONTINUING MEDICAL EDUCATION (CME) EVENT

More than 90 physicians, physician as-sistants, nurses and certified athletic trainers attended “Office Orthopaedics for the Primary Care Physician.” The CME event co-sponsored by Common-wealth Orthopaedics and Inova Health System consisted of a half day work-shop on topics such as: What Not to Miss in a Pre-Participation Exam, Acute and Chronic Knee Pain, Shoulder Pain, Back Pain, Hand and Wrist Pain and the Ten Diagnoses Not to Miss.

Attendees participated in hands on demonstrations on how to examine knees and shoulders, give steroid injec-tions, and they learned proper splinting techniques.

NEW PHYSICAL THERAPY CLINIC OPENS

Our newest physical therapy clinic opened on the campus of Inova Fair Oaks Hospital at 3620 Joseph Siewick Drive, Suite 100A, Fairfax, VA.

Appointments are available Monday – Thursday from 7:00 a.m. to 7:00 p.m.

Friday from 7:00 a.m. - 5:00 p.m.

CALL 703-810-5227





95.3%

98.6%

99.9%





0 3,000 6,000 9,000 12,000

Fracture Care 1,017

Surgeries 677


Consults 503





Arthroscopies6,965

Other2,730

Spine1,334

Arthroscopies6,965

Total Joint1,723

Hand1,076

Shoulder700Foot and

Ankle360

Knee3,423

Shoulder1,182

Bankart233Menisical

Repair232

Other97

ACL734


297

Hip767 Arlington

13,232

Fairfax14,881

Reston14,544

Fair Oaks1,872

(opened 11/1/12)

Herndon13,201

Tysons11,415

Springfield11,600







Established124,529

New32,463

Pediatrics18,082

Consults6,634

Fracture Care


Surgical 1,696

Non-surgical 2,380



2,476

2,002


New Patients 4,812







photo: jose argueta





95.3%

98.6%

99.9%





0 3,000 6,000 9,000 12,000

Fracture Care 1,017

Surgeries 677


Consults 503





Arthroscopies6,965

Other2,730

Spine1,334

Arthroscopies6,965

Total Joint1,723

Hand1,076

Shoulder700Foot and

Ankle360

Knee3,423

Shoulder1,182

Bankart233Menisical

Repair232

Other97

ACL734


297

Hip767 Arlington

13,232

Fairfax14,881

Reston14,544

Fair Oaks1,872

(opened 11/1/12)

Herndon13,201

Tysons11,415

Springfield11,600







Established124,529

New32,463

Pediatrics18,082

Consults6,634

Fracture Care


Surgical 1,696

Non-surgical 2,380



2,476

2,002


New Patients 4,812







photo: jose argueta





95.3%

98.6%

99.9%





0 3,000 6,000 9,000 12,000

Fracture Care 1,017

Surgeries 677


Consults 503





Arthroscopies6,965

Other2,730

Spine1,334

Arthroscopies6,965

Total Joint1,723

Hand1,076

Shoulder700Foot and

Ankle360

Knee3,423

Shoulder1,182

Bankart233Menisical

Repair232

Other97

ACL734


297

Hip767 Arlington

13,232

Fairfax14,881

Reston14,544

Fair Oaks1,872

(opened 11/1/12)

Herndon13,201

Tysons11,415

Springfield11,600







Established124,529

New32,463

Pediatrics18,082

Consults6,634

Fracture Care


Surgical 1,696

Non-surgical 2,380



2,476

2,002


New Patients 4,812







photo: jose argueta





95.3%

98.6%

99.9%





0 3,000 6,000 9,000 12,000

Fracture Care 1,017

Surgeries 677


Consults 503





Arthroscopies6,965

Other2,730

Spine1,334

Arthroscopies6,965

Total Joint1,723

Hand1,076

Shoulder700Foot and

Ankle360

Knee3,423

Shoulder1,182

Bankart233Menisical

Repair232

Other97

ACL734


297

Hip767 Arlington

13,232

Fairfax14,881

Reston14,544

Fair Oaks1,872

(opened 11/1/12)

Herndon13,201

Tysons11,415

Springfield11,600







Established124,529

New32,463

Pediatrics18,082

Consults6,634

Fracture Care


Surgical 1,696

Non-surgical 2,380



2,476

2,002


New Patients 4,812







photo: jose argueta






95.3%

98.6%

99.9%





0 3,000 6,000 9,000 12,000

Fracture Care 1,017

Surgeries 677


Consults 503





Arthroscopies6,965

Other2,730

Spine1,334

Arthroscopies6,965

Total Joint1,723

Hand1,076

Shoulder700Foot and

Ankle360

Knee3,423

Shoulder1,182

Bankart233Menisical

Repair232

Other97

ACL734


297

Hip767 Arlington

13,232

Fairfax14,881

Reston14,544

Fair Oaks1,872

(opened 11/1/12)

Herndon13,201

Tysons11,415

Springfield11,600







Established124,529

New32,463

Pediatrics18,082

Consults6,634

Fracture Care


Surgical 1,696

Non-surgical 2,380



2,476

2,002


New Patients 4,812







photo: jose argueta


95.3% Physician office patients

98.6% Outpatient surgery center patients

99.9% Physical therapy patients

In 2012, Commonwealth Orthopaedics welcomed three new physicians:

(pictured left to right)

Frederick D. Scott, Jr., MD Specializing in hand and upper extremity

Peter R. Thomas, MD Specializing in hand and upper extremity

Anthony L. Avery, MD Specializing in sports medicine


Orthopaedic Surgery/Medicine

Arthroscopic Surgery

Sports Medicine

Fracture Care

Total Joint Replacement

Hand & Upper Extremity Surgery

Shoulder Surgery

Knee Surgery

Spine Surgery

Foot and Ankle Surgery

Trauma Care

Pain Management

Physiatry

Arthritis

Minimally Invasive Surgery

• Total Joint

• Spine

Physical Therapy and Rehabilitation

Areas of Expertise:



Teaming Up to Improve Community HealthCommonwealth Begins Second Year of Redskins Partnership

As the exciting Redskins season unfolds, Commonwealth Orthopaedics continues its role as the team’s official orthopaedic and physical therapy partner. Commonwealth surgeons and

physical therapists (PTs) work together with the Redskins to promote community health and wellness initiatives and make Redskins fans the healthiest in the NFL.

This is the second year of a four-year partnership. Commonwealth’s physicians contribute articles for the Redskins Health and Wellness magazine and answer fan questions as part of the “Ask the Expert” feature on the team’s website: redskinshealthandwellness.com.

Physicians and PTs lend their time and talents to community events, too. During the first year, they participated in the Redskins Play 60 Mini-Combine, an ultimate fitness class to educate local middle school students on injury prevention, physical fitness and concussion safety. And they helped host a reading event for Redskins Kids Club members that included agility and strengthening exercises, a mini obstacle course and injury prevention tips for parents.

Commonwealth and the Redskins share a long and proud history. For many years, Commonwealth’s surgeons have served as the Redskins’ team physicians, providing orthopaedic expertise to keep players in top condition. Surgeons Christopher Annunziata, MD, David Novak, MD and Andrew Parker, MD are the team physicians this season.

“Commonwealth looks forward to another successful year as the official orthopaedic and physical therapy partner of the Washington Redskins,” says Commonwealth President Gordon Avery, MD. “We are proud to continue this important partnership to improve our community’s health.”

Redskin Kids Club members enjoy the agility exercises provided by Commonwealth Physical Therapists at a recent event at Redskins Park.

Area children learned the importance of stretching as demonstrated by Commonwealth Physical Therapists.

Redskin Kids Club members enjoy the agility exercises provided by Commonwealth Physical Therapists at a recent event at Redskins Park.

SEE IF XIAFLEX CAN HELP Prescription XIAFLEX is the fi rst and only FDA-approved nonsurgical treatment for adults with Dupuytren’s contracture when a “cord” can be felt. It’s a medication given as part of an in-offi ce procedure, with no surgery or general anesthesia required to administer. Studies show that XIAFLEX may help straighten the affected fi nger and improve range of motion. So tell your doctor you’d like to take a closer look at all your treatment options—and ask about XIAFLEX today.

IMPORTANT SAFETY INFORMATION XIAFLEX can cause serious side effects including tendon rupture (break), ligament damage, nerve injury or other serious injury of the hand, or allergic reaction. Surgery could be required to fi x the damaged tendon or ligament.

Call your doctor right away if you have trouble bending your injected fi nger after the swelling goes down, pain, tingling, numbness, or problems using your treated hand or if you get hives, swollen face, breathing trouble, or chest pain.

It’s important to tell your doctor about a prior allergic reaction to XIAFLEX, or if you have a bleeding problem or use a blood thinner.

Common side effects include hand swelling, bruising, injection site reaction or bleeding, and pain.

XIAFLEX should be injected into the cord by a healthcare provider who is experienced in injection procedures of the hand and treating people with Dupuytren’s contracture.

You are encouraged to report negative side effects of prescription drugs to the FDA at www.FDA.gov/medwatch or 1-800-FDA-1088.

Please see Important Product Information on the following page.

FOR ADULTS WITH DUPUYTREN’S CONTRACTURE WHEN A “CORD” CAN BE FELT

XIAFLEX FOR INJECTION

IT’S TIME TO TAKE A CLOSER LOOK

More and more doctors have treated with XIAFLEX. Visit XIAFLEX.com to fi nd an experienced hand specialist in your area today.

© 2013 Auxilium Pharmaceuticals, Inc. All rights reserved. XDC-00398FOR MORE INFORMATION, CALL 1-877-XIAFLEX

R1122_PrintAd_7.75"x10.25".indd 1 8/8/13 3:14 PM

Important Product Information

XIAFLEX® (Zï a flex)

(collagenase clostridium histolyticum)

What is the most important information

I should know about XIAFLEX?

XIAFLEX can cause serious side

effects, including:

1. Tendon rupture or ligament damage.

Receiving an injection of XIAFLEX may cause

damage to a tendon or ligament in your hand

and cause it to break or weaken. This could require

surgery to fix the damaged tendon or ligament.

Call your healthcare provider right away if you

have trouble bending your injected finger (towards

the wrist) after the swelling goes down or you

have problems using your treated hand after

your follow-up visit.

2. Nerve injury or other serious injury of

the hand. Call your healthcare provider right

away if you get numbness, tingling, or increased

pain in your treated finger or hand after your

injection or after your follow-up visit.

3. Allergic Reactions. Allergic reactions can

happen in people who take XIAFLEX because

it contains foreign proteins.

Call your healthcare provider right away if

you have any of these symptoms of an allergic

reaction after an injection of XIAFLEX:

hives; swollen face; breathing trouble; chest pain.

What is XIAFLEX?

XIAFLEX is a prescription medicine used to treat

adults with Dupuytren’s contracture when a

“cord” can be felt.

In people with Dupuytren’s contracture, there is

thickening of the skin and tissue in the palm of your

hand that is not normal. Over time, this thickened

tissue can form a cord in your palm. This causes one

or more of your fingers to bend toward the palm,

so you can not straighten them.

XIAFLEX should be injected into a cord by a

healthcare provider who is skilled in injection

procedures of the hand and treating people with

Dupuytren’s contracture. The proteins in XIAFLEX

help to “break” the cord of tissue that is

causing the finger to be bent.

It is not known if XIAFLEX is safe and effective

in children under the age of 18.

What should I tell my healthcare provider

before starting treatment with XIAFLEX?

XIAFLEX may not be right for you. Before receiving

XIAFLEX, tell your healthcare provider if you:

• have had an allergic reaction to a previous

XIAFLEX injection.

• have a bleeding problem.

• have any other medical conditions.

• are pregnant or plan to become pregnant.

It is not known if XIAFLEX will harm

your unborn baby.

• are breastfeeding. It is not known if XIAFLEX

passes into your breast-milk. Talk to your healthcare

provider about the best way to feed your baby

if you receive XIAFLEX.

Tell your healthcare provider about all the medicines

you take, including prescription and non-prescription

medicines, vitamins, and herbal supplements.

Especially tell your healthcare provider if you use:

a blood thinner medicine such as aspirin, clopidogrel

(PLAVIX®), prasugrel hydrochloride (EFFIENT®), or

warfarin sodium (COUMADIN®). If you are told to stop

taking a blood thinner before your XIAFLEX

injection, your healthcare provider should tell you

when to restart the blood thinner.

How will I receive XIAFLEX?

Your healthcare provider will inject XIAFLEX into

the cord that is causing your finger to bend.

After an injection of XIAFLEX, your affected hand

will be wrapped with a bandage. You should limit

moving and using the treated finger after

the injection.

Do not bend or straighten the fingers of the

injected hand until your healthcare provider says

it is okay. This will help prevent the medicine from

leaking out of the cord.

Do not try to straighten the treated finger yourself.

Keep the injected hand elevated until bedtime.

Call your healthcare provider right away if you have:

signs of infection after your injection, such as fever,

chills, increased redness, or swelling; numbness or

tingling in the treated finger; trouble bending the

injected finger after the swelling goes down.

Return to your healthcare provider’s office as

directed on the day after your injection. During this

first follow-up visit, if you still have the cord, your

healthcare provider may try to extend the treated

finger to “break” the cord and try to straighten

your finger.

Your healthcare provider will provide you with

a splint to wear on the treated finger. Wear the

splint as instructed by your healthcare provider

at bedtime to keep your finger straight.

Do finger exercises each day, as instructed

by your healthcare provider.

Follow your healthcare provider’s instructions

about when you can start doing your normal

activities with the injected hand

What are the possible side effects

of XIAFLEX?

XIAFLEX can cause serious side effects.

See “What is the most important information

I should know about XIAFLEX?”.

Common side effects with XIAFLEX

include: swelling of the injection site or the hand;

bleeding or bruising at the injection site; pain or

tenderness of the injection site or the hand;

swelling of the lymph nodes (glands) in the elbow

or underarm; itching; breaks in the skin; redness

or warmth of the skin; pain in the underarm.

These are not all of the possible side effects with

XIAFLEX. Tell your healthcare provider about any

side effect that bothers you or does not go away.

Call your doctor for medical advice about

side effects. You may report side effects to

the FDA at 1-800-FDA-1088.

General information about XIAFLEX

Medicines are sometimes prescribed for

purposes other than those listed here.

This is a summary of the most important

information about XIAFLEX. If you would like

more information, talk to your healthcare

provider. You can ask your healthcare provider

for information about XIAFLEX that is written

for health professionals.

For more information visit

www.XIAFLEX.com or call 1-877-663-0412.

Registered trademarks are the property

of their respective owners.

© 2013 Auxilium Pharmaceuticals, Inc.

For US residents only.

Auxilium Pharmaceuticals, Inc.

640 Lee Road

Chesterbrook, PA 19087

www.auxilium.com

XDC-00398

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All her life, Millie has been active – raising six children, bowling in a league, even skating in

the roller derby 60 years ago. But when the 81-year-old from Chantilly began experiencing difficulty raising her arms to complete simple tasks such as brushing her hair or reaching up to a shelf, she knew something was wrong. Her limited range of motion also made it hard to do her office job at Louise Archer Elementary School in Vienna.

Millie consulted Commonwealth surgeon David Novak, MD, who diagnosed advanced osteoarthritis in both her shoulders. When several months of cortisone shots failed to alleviate her symptoms, she opted for a total shoulder replacement on her left side.

This procedure involves replacing the arthritic joint surfaces with a metal and plastic implant. The components come in various sizes and are either cemented or press fit into the bone. “Patients like Millie, with end-stage arthritis and intact rotator cuff tendons, who no longer respond to conservative treatment – such as NSAIDs, cortisone or physical therapy – are generally good candidates for total shoulder replacement,” Dr. Novak explains.

The surgery restored function to Millie’s left shoulder and she was able to use that arm to drive and perform basic activities at work. But within a year she had returned to Dr. Novak with worsening symptoms on her right side. This time, standard total shoulder replacement was not an option; the damage was too severe. Dr. Novak suggested something different: reverse total shoulder replacement.

This exciting breakthrough in shoulder surgery is a new treatment option for patients whose conditions previously had no solution. In a reverse total shoulder replacement, the socket and metal ball are switched. Afterwards, patients use their deltoid muscle, instead of their rotator cuff, to lift their arm overhead. Candidates for reverse total shoulder replacement include patients with unrepairable rotator cuff tears, no range of motion in the shoulder joint and severe shoulder fractures.

Dr. Novak is among just a handful of surgeons in the area who perform this advanced procedure.

Following both of her surgeries, Millie wore a sling for four weeks. She spent two months working with a physical therapist on exercises to regain range of motion and strengthen her shoulder joint. It was all part of a rigorous rehabilitation program that every patient goes through.

“Recovery from shoulder replacement surgery can range anywhere from three to six months, depending on the patient and the type of procedure performed,” says John McConnell, MD, a Commonwealth surgeon whose areas of specialization include total joint replacement and sports medicine. “Generally, patients are able to resume an active lifestyle, including most sports, with some restrictions on overhead activities.”

Motion and strength are back in both of Millie’s shoulders and she’s able to perform the simple, everyday activities she couldn’t do before, such as holding a hairdryer over her head or reaching up to sort the mail at work.

She praises Dr. Novak’s skill and is grateful to have a resource such as Commonwealth Orthopaedics close to home. “Dr. Novak always


Reversing the DamageBreakthrough in Shoulder Surgery Brings New Hope to Patients

After a shoulder replacement, Millie is back to the job she loves at Louise Archer Elementary School.


John P. McConnell, MD, earned a BS in Chemistry from Georgetown University in Washington, DC, and also received his medical degree from Georgetown University Medical School. He then completed a general surgery internship at Northshore University Hospital in Long Island, New York, and returned to

Washington to do an orthopaedic surgery residency at Georgetown University Medical Center.

David J. Novak, MD, earned a BA in Economics from the University of Pennsylvania and received his medical degree from Georgetown University. He remained in Washington, DC, at Georgetown University Medical Center to complete a residency in orthopaedic surgery. He then completed advanced fellowship training in sports medicine and arthroscopy at the Southern

California Orthopedic Institute in Van Nuys, California.


took the time to clearly explain everything that was going on, he visited me in the hospital and he took excellent care of me,” she says. “I just think he’s the best, and everyone at Commonwealth, too. They were all very good to me.”

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Double TroubleTennis Partners Return from Rotator Cuff Surgery to Win Doubles Title

International Country Club tennis partners Cory and Jim are not your ordinary doubles champions. At 57 and 58, they are the oldest combined pairing to win the championship in the

club’s history. What makes it even more remarkable: they came back to defend their title after both had rotator cuff surgery.

Cory’s injury took place several years ago during warm-ups for an interclub match. He felt a sudden, sharp pain in his right shoulder while hitting an overhead shot. At first he thought he’d pulled a muscle and rested it for a few weeks. But when he got back on the court and tried to serve, the pain was still there.

Cory consulted fellow club member Keith Lawhorn, MD, at Commonwealth Orthopaedics, who initially recommended physical therapy. When the pain persisted, and an MRI revealed a tear, Cory opted for a surgical repair.

“Surgery was necessary if I wanted to return to playing tennis competitively – the way I am used to,” he says. “It helped that Dr. Lawhorn is a tennis player and understands how important tennis is to me in my life. It gave him great insight into what it would take to return me to a high level of play.”

Jim had partially torn his rotator cuff 30 years earlier while on the U.S. Olympic handball training team and the injury had worsened over time. When he hit a routine shot during a mixed doubles match, he felt a pop and some pain in his left shoulder. Although he was able to complete play, he woke up the next morning in severe pain, barely able to lift his left arm.

Encouraged by Cory’s experience, Jim consulted Dr. Lawhorn, too. “I wanted surgery right away, but Dr. Lawhorn recommended trying some non-operative options first, including rehabilitation to provide strengthening of the surrounding tissue,” he says. Ultimately, however, Jim ended up having a surgical repair.

“Both Cory and Jim had moderate-sized rotator cuff tears involving their dominant shoulders, and had conventional true double-row repairs, performed with an all-arthroscopic technique,” Dr. Lawhorn explains. “Both patients underwent a conservative rehabilitation protocol, beginning physical therapy four weeks after surgery and progressing to strengthening and tennis ground strokes at six to nine months. They returned to full play, including unrestricted serving, at one year.”

Jim (left) and Cory are the oldest combined pairing to win the doubles championship in the history of the International Country Club in Chantilly, VA.


Thomas J. Klein, MD, earned a BA in biology from Washington and Jefferson College before going on to graduate from medical school at Georgetown University School of Medicine. He completed his surgical internship in Danville, Pennsylvania, and did an orthopaedic surgery residency at Georgetown University Medical Center.

Keith Lawhorn, MD, graduated with a BA in Chemistry from the University of Virginia and continued his education at the University of Virginia School of Medicine, where he earned his medical degree. He completed a general surgery internship and orthopaedic residency at the Medical College of Virginia. Dr. Lawhorn served on active duty in the U.S. Air Force for eight years, reaching the rank of Lt. Colonel.


The rotator cuff is a group of muscles and tendons that stabilizes the shoulder joint and helps raise and rotate the arm. Surgery is used to treat a rotator cuff tear if the injury is very severe or if nonsurgical treatment has failed to sufficiently improve strength and movement. Thanks to advancements in arthroscopic techniques and materials, surgeons can perform successful rotator cuff repairs on patients of all ages and activity levels using very small incisions – procedures that might not have been possible 20 years ago.

Ideal candidates are those with good quality rotator cuff tissue who suffer an acute tear. After the repair of acute tears, symptom relief and functional recovery is high. For older patients with natural degeneration, the decision to have surgery is based on a number of factors including symptoms, function, repairability and tissue quality.

“As we age, the rotator cuff thins like a pair of worn jeans,” explains Commonwealth surgeon Thomas Klein, MD. “It happens slowly over time, getting thinner and thinner, until it finally tears. Some patients can function very well without surgery. But others – especially those who experience night pain or marked weakness – require a surgical repair.”

Rehabilitation is a slow process that is key to a successful outcome. It begins with four to six weeks of immobilization in a sling, followed by a month of passive physical therapy to regain range of motion, and several months of active therapy to improve strength and control.

“Returning overhead athletes with rotator cuff tears to their pre-injury level of function is a challenge,” says Dr. Lawhorn. “In fact, tennis players such as Jim and Cory are some of the most challenging patients to return to this high level. The rehabilitation, as well as the time course for return, must be conservative.”

Both men appreciated this approach. “It was absolutely 100% the right thing to do,” Jim says. “At the time, I was pushing for a faster

Cory (left) and Jim remain doubles champions at their club after both having rotator cuff surgeries.

return, but Dr. Lawhorn refused to let me do too much too soon and now my shoulder feels better than it ever has before.”

Cory, who feared his injury had ended his tennis career, was equally grateful he did not rush back to the court. “When I finally attempted a gentle serve, and felt absolutely no discomfort whatsoever – relief just washed over me. It felt like I had a brand new arm,” he says.

The pair put their repaired shoulders to the ultimate test in February, winning International’s doubles championship for the second time in four years. Everyone they played was younger, including some father-son teams. Their goal is to defend their title – and set new combined age records – for as long as they can.

“We feel so fortunate and owe it all to the excellent care we received from Commonwealth Orthopaedics and Dr. Lawhorn,” Jim says. “He is one of my true heroes.”

Growing up, Anthony Avery, MD, never dreamed of becoming a doctor. Even when he tagged along with his father, Gordon Avery, MD, on hospital rounds, he

remained unimpressed. “I definitely wasn’t the kid with the little toy stethoscope around my neck,” he says. His interests leaned toward chemistry and political science.

But when it came time to pick a career track at Villanova University, Anthony felt the pull toward medicine. He took the MCATs, did well, and went on to earn his medical degree from Georgetown University School of Medicine. By then, it was clear that orthopaedics was the specialty that fit him best. He completed clinical training at Monmouth Medical Center, The Children's Hospital of Philadelphia and Morristown Memorial Hospital, followed by a sports medicine and arthroscopy fellowship at Brown University.

His father was as amazed as anyone by this turn of events. “Anthony didn’t express any interest in medicine as a child and never talked to me about going to medical school,” Dr. Gordon

Avery says. “The first time his mother and I had any inkling was when we noticed an MCAT application on the kitchen table.”

As Anthony began looking for work, he remained determined to carve out his own identity. He resisted the idea of joining the same practice as his father and searched for jobs in other cities such as Chicago and New York. “I didn’t want to follow in my dad’s footsteps, I wanted to make my own footsteps,” he says. “I tried to keep an open mind and find the place with the best fit; the place I’d feel most at home.” That special place turned out to be Commonwealth. With the timing and opportunity right, he joined the staff in 2012.

Now the young orthopaedic surgeon’s days are filled with sports medicine and trauma cases. He loves the acute aspect of his work and the immediate positive impact he has on his patients – fixing their injuries, restoring their mobility and returning them to the activities they enjoy. He calls it an honor to play a part in this very emotional and often life-changing experience.

The father/son team of Gordon Avery, MD (left) and Anthony Avery, MD work in our Arlington and Tysons offices.


All in the Family

Anthony L. Avery, MD, received a BS in Chemistry from Villanova University and earned his medical degree from Georgetown University School of

Medicine. He then completed five years of orthopaedic surgery training including clinical training at Monmouth Medical Center, The Children's Hospital of Philadelphia and Morristown Memorial Hospital. Dr. Avery went on to Brown University to complete a fellowship in sports medicine and arthroscopy.

Gordon L. Avery, MD, earned his undergraduate degree from Ithaca College in Ithaca, New York, before going on to receive his medical degree from The

University of New York at Buffalo, College of Medicine. He then moved to Washington, DC, and completed his internship and orthopaedic residency at Georgetown University Medical Center where he concluded his formal medical training as Chief Resident.

His proud father couldn’t be happier and believes orthopedic trauma is the perfect fit for his son. “Anthony has a remarkable work ethic and a great ability to do things with his hands. As a kid, he was always taking things apart and putting them back together,” he says.

In choosing medicine, Dr. Anthony Avery is carrying on a family tradition that reaches back four generations. His mother, two aunts, two great-aunts and his great-grandmother were all nurses. His sister is a nurse practitioner in New York City. And he feels right at home at Commonwealth, even helping out his father on several tough cases. “The experience has been great and all fears about working with my dad have vanished,” he says. “When I was looking for a place to practice, time and again people would say to me: ‘Commonwealth is where you want to be; you won’t find anything better.’ And they were right.”

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