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Spring 2011 Getting back to your life. www.c-o-r.com Complex Knee Surgeries Restore High-Velocity Lifestyle AlexAndriA • Arlington • Burke • FAir oAkS • FAirFAx • Herndon • reSton • SpringField • tySonS Corner Nascott Orthotics and Prosthetics With you for life. 3601-A Chain Bridge Road • Fairfax, VA 22030 • 703-691-0606 102 Irving Street, NW • Washington, DC 20010 • 202-877-1497 15005 Shady Grove Road • Rockville, MD 20850 • 301-424-2341 Caring, dependable, supportive. Nascott is the premier provider of adult and pediatric orthotics and prosthetics in the Washington, DC Metropolitan area. At Nascott, we build lasting patient relationships to ensure the medically appropriate orthopedic brace or prosthetic fits you and your changing daily activities. 800-801-3335 Commonwealth Orthopedics PROUD PARTNER nascott.com Diagnostic Health Your Imaging Center of Choice! OrthoCareRN HomeCare for BoneCare When Home Rehabilitation Matters… Select an Agency with Experience! Services we offer: MRI/MRA (High-Field, 1.5T & 3.0T) Arthrograms (CT-guided injection) Computed Tomography (CT Scan) Ultrasound/Doppler X-ray Services Provided Monday – Friday Orthopaedic Rehabilitation 7:00 a.m. to 10:00 p.m. PT/ OT/ RN/ LPN/ CNA Saturday & Sunday 7:30 a.m. to 5:00 p.m. (MRI only) Ask your Doctor or Nurse about requesting OrthoCareRN services. 7799 Leesburg Pike, Suite 104-S Falls Church, VA 22043 Call 703.481.1919 P: 703.893.2820 | F: 703.827.2685 www.OrthoCareRN.com www.dxhealthcorp.com Welcoming Remarks I am pleased to present the 10th issue of Commonwealth Orthopaedics Magazine! When we began this publication back in 2007, our goal was to reach out to our fellow physicians in the community to keep you, your staff, and your patients informed about the latest advancements in orthopaedic care and services. Now, we’ve expanded our communication efforts with the launch of our new Commonwealth Orthopaedics Blog. For nearly six months, our physicians have been Corporate Office 11240 Waples Mill Rd., Ste. 403 sharing their expertise and advice about a variety of orthopaedic conditions, cutting-edge Fairfax,VA 22030 treatments, and injury prevention techniques. Our blog includes first-person accounts, (703) 810-5200 • (703) 383-6465 fax Q&A, physician videos, surgical animations, and more. We encourage you and your www.c-o-r.com staff to visit at http://blog.c-o-r.com or via our website, www.c-o-r.com. And be sure to recommend the blog to your patients. Office Locations Alexandria Herndon At Commonwealth, we like to think of ourselves as one big family. For two of our physicians – Frank Pettrone, MD and Sarah Pettrone, MD – it’s actually true. In this issue Arlington Reston of our magazine, read how this father-daughter duo inspire and challenge each other every Burke Springfield day. Fairfax Tysons Corner We also have some compelling patient stories to share. Find out about a triathlon coach Fair Oaks who is back on the Ironman circuit after arthroscopic hip surgery, a Division 1 lacrosse player whose shoulder repair finally fixed recurring dislocations, a Herndon mother’s complex and technically demanding knee surgeries, and an Annandale homemaker who President overcame her fears to have successful spinal fusion. Gordon L. Avery, MD As always, we appreciate your support and the opportunity to provide your patients with Chief Executive Officer world-class orthopaedic and rehabilitation services in Northern Virginia. William L. Harvey Sincerely, Chief Operating Officer Maureen M.R. Cook Chief Financial Officer Richard T. Givens Gordon L. Avery, MD President Director of Physical Therapy Commonwealth Orthopaedics Jo-Anne Burton, PT Director of Human Resources Michelle Melito Directors of Marketing Contents Suzanne M. Kelly Deborah R. Martin “Ben Is The Man” ........................................................................4 Like Father, Like Daughter ........................................................6 Treating a Pain in The Neck ......................................................8 Editorial Mission: Commonwealth Orthopaedics magazine is an educational Nothing to Fear ........................................................................ 10 and informative resource for physicians, health care professionals, employer groups, Targeted Relief for Low Back Pain ....................................... 12 and the general public. This publication provides a forum for communicating news Commonwealth Orthopaedics in the Community .......... 13 and trends involving orthopaedic-related On the cover: diseases, injuries, and treatments, as well as Mary underwent two sur- Best Foot Forward................................................................... 14 other health-related topics of interest. geries on her knee to enable Going The Distance ................................................................. 16 her to continue with her ac- tive lifestyle. In one short Complex Knee Surgeries Restore Commonwealth Orthopaedics year following the surgeries, High-Velocity Lifestyle ............................................................. 18 magazine is designed Mary was hiking in the Great and published by In Memoriam ............................................................................. 20 Medical Custom Medical Smoky Mountains and skiing Design Group, Inc. To black diamond slopes. See Advertiser Directory .............................................................. 21 adver tise in an upcoming her story on page 18. issue please contact: 800.246.1637 or Orthotics & Braces.................................................................. 21 CustomMedicalMagazine.com This publication may not be reproduced in par t Keeping Patients Informed and Educated ........................... 22 or whole without the express written consent of Custom Medical Design Group, Inc Meet Our Physicians................................................................ 23 “Ben Is the Man” Shoulder Surgery Returns Local Lacrosse Player to Highest Level of Competition A Following surgeries for a dislocated s a star lacrosse player in high school, Sam dislocated his shoulder so many times he became an expert at popping shoulder, Sam is having it back in. Eventually, his concerned parents took him a successful season to see Ben Kittredge, MD, an orthopaedic surgeon playing Division I and sports medicine specialist at Commonwealth Orthopaedics. Dr. Kittredge had a simple message for the Edgewater, Maryland lacrosse at Lehigh teenager: “If you want this to stop, you’ll have to have surgery.” University. Sam’s multiple shoulder dislocations had caused an injury known as a Bankart lesion in the lower part of his labrum, the cartilage that surrounds and cushions the shoulder joint. Both Bankart injuries and SLAP lesions, which damage the uppermost area of the labrum, are common in young overhead athletes, especially throwers, swimmers and those playing contact sports. Treatment includes physical therapy and rehabilitation to strengthen the shoulder muscles or, in more serious cases, arthroscopic or open surgery to reattach the torn tissue. “At Commonwealth, we see a very large athletic population and do a lot of these procedures,” says Dr. Kittredge, who performed surgery to repair Sam’s left shoulder and later his right shoulder. “Many of us have fellowship training in sports medicine, which makes us highly qualified. In addition, the quality of a patient’s diagnostic tests – and the expertise of the radiologist who reads and interprets those tests – is extremely important to ensure timely, appropriate treatment. We send our patients to the area’s best facility with the best radiologists for MRIs and arthrograms.” If an athlete suffers a Bankart or SLAP injury in the middle of the season, non-operative methods are sometimes an option. “We might try using a brace to protect the shoulder so it doesn’t dislocate, and we work with the physical therapist to strengthen the surrounding shoulder girdle muscles to try to keep the ball in the socket and provide muscular stability,” says Kevin Sumida, MD, a Commonwealth Orthopaedics surgeon and sports medicine specialist. Older patients with SLAP tears are often able to avoid surgery with rest, anti-inflammatory medication, and other conservative treatments. But the vast majority of patients under 20 with a dislocated shoulder will typically require an operation. If surgery is necessary, Commonwealth offers the latest minimally invasive techniques. “Because we perform these procedures Video Extra! arthroscopically, we don’t need to make an open incision or disrupt the normal anatomy to get to where the problem is,” explains David Dr. Sumida explains Shoulder Novak, MD, an orthopaedic surgeon and sports medicine specialist Bankart Repair at at Commonwealth. “This tendon-preserving method is not only www.c-o-r.com/videos much easier on the patient, it also allows us to access all areas of the shoulder joint and create a more balanced repair better than a traditional, open procedure.” 4 Commonwealth Orthopaedics | www.c-o-r.com Both of Sam’s surgeries were extremely successful and he has not had a shoulder dislocation since. In each case, he spent six months in rehabilitation before returning to the playing field. He is now a freshman playing Division I lacrosse at Lehigh University in Pennsylvania, where he was recruited out of high school. The season includes games against top teams such as Army, Navy, and Bucknell. “Sam had a great outcome and our family was very pleased with the whole experience at Commonwealth,” says Sam’s father, Bruce. “We would recommend Dr. Kittredge to anyone. He has a great demeanor and he tells it like it is. Sam doesn’t always listen to me, but he listens to Dr. Kittredge. He follows his rules and he respects him. As Sam says, ‘Ben is the man.’ ” At Professional Risk Associates we focus solely on Physician Professional Liability Ben W. Kittredge, IV, MD earned an Insurance. This is what we have been undergraduate degree from the University of doing for over 20 years. Virginia and a Masters degree in Physiology from Georgetown University. Dr. Kittredge then returned to the University of Virginia to We currently serve several thousand attain his medical degree. He then completed a physicians and healthcare providers in general surgery internship at Roanoke Memorial Hospital and an orthopaedic residency at the University of Virginia. the Mid-Atlantic region, and represent Additionally, Dr. Kittredge completed a fellowship in sports several of the industry’s largest medical medicine at Jefferson Medical College and Pennsylvania Hospital in professional liability carriers, Philadelphia. all rated “Excellent” by A.M. Best. David J. Novak, MD earned a BA in Economics from the University of Pennsylvania and received Use our experience and personal attention his medical degree from Georgetown University. for your practice to help select the He remained in Washington, DC, at Georgetown University Medical Center to complete a right coverage and carrier for you. residency in orthopaedic surgery. He then completed advanced fellowship training in sports If you are interested in finding out how medicine and arthroscopy at the Southern California Orthopedic Institute in Van Nuys, California. Professional Risk can assist your practice, please give us a call at 1-800-318-9930 Kevin D. Sumida, MD, graduated with a BA from DePauw University in Greencastle, or email us at: Indiana and then earned a medical degree from email@example.com the University of Kentucky College of Medicine in Lexington. He completed his orthopaedic surgery training in Lexington before completing Visit us on the web at a fellowship in Sports Medicine at the University www.profrisk.com of North Carolina at Chapel Hill. In addition to his orthopaedic practice, he is also a clinical assistant professor at Georgetown University. 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 Like Father, Sarah Pettrone, MD, continues her Like Daughter father’s legacy, Dr. Frank Pettrone, as an orthopaedic surgeon at Commonwealth Orthopaedics. W hen his daughters were young, Commonwealth For Dr. Sarah Pettrone, becoming an orthopaedic surgeon like her Orthopaedics surgeon Frank Pettrone, MD, father was not always in the cards. She excelled academically and would often take them along on rounds at the athletically and was initially interested in a career in women’s health. hospital. “They’d come with me on the weekends,” After graduating summa cum laude from Notre Dame, she earned he recalls. “They spent a lot of time in the doctor’s lounge listening her medical degree from the University of Virginia, where she was to everyone, or they’d be in the anesthesia lounge while I was in selected a Bowman Scholar. It was during her clinical rotations in the next room working on a case.” That early exposure rubbed off. medical school that she realized she liked orthopaedics best. She Two of his daughters are now physicians: Kristen, an emergency went on to complete an internship and residency in joint disease medicine doctor in Winchester, VA, and Sarah, a hand and upper at New York University, followed by a hand and upper extremity extremity specialist at Commonwealth Orthopaedics. fellowship at the University of Washington in Seattle. Having another orthopaedic surgeon in the family makes Dr. Frank When it came time to look for a job, her first choice was Pettrone one proud dad. “As a parent, you are always happy to see Commonwealth Orthopaedics. The timing was right: your children succeed in life and in careers, but it’s a special feeling Commonwealth needed a hand surgeon, and Sarah happily when they choose to do what you do. It makes you feel you did returned home to Northern Virginia to begin her medical career something right while they were growing up,” he says. working alongside her father. 6 Commonwealth Orthopaedics | www.c-o-r.com Because your knees “My dad has always been my role model,” she says. “It’s hard support your game. not to be influenced by someone who, 30 years on, still loves his job as much as the day he started. Growing up, I never once If you have osteoarthritis (OA) of the knee, and pain relievers aren’t helping, there is a non-surgical option heard my dad say he didn’t want to go to work. He loves being that may help keep you moving and get your knees around people and he loves his patients. He’s always running back in the game. ORTHOVISC® provides up to 6 months of knee pain late in clinic because he will sit and talk to each patient. As a relief with just three injections. Made from ultra-pure new physician, these are important skills I am trying to learn natural hyaluronan, which is found in healthy joints, ORTHOVISC® acts to cushion, protect and lubricate from my dad: how to talk to patients, make them feel at ease, your knee. and really listen to what they are telling me.” As an Official Health and Fitness Provider for the PGA TOUR and CHAMPIONS TOUR, ORTHOVISC® may be Now, father and daughter not only share a profession, but also just what you need to get back on the course. To learn more, call DePuy Mitek at 1-800-382-4682 participate in medical research and collaborate on cases. Sarah or visit www.orthovisc.com recently performed surgery on a George Mason University basketball player with a difficult wrist fracture and dislocation. Her father was her surgical assistant. “Looking across the table and watching my daughter preside over such a complicated AN OFFICIAL HEALTH AND FITNESS PROVIDER case, where she’s the boss, really made me think back to when she was a little girl accompanying me on my hospital rounds,” Important Safety Information ORTHOVISC® is for patients who do not get adequate pain relief from simple pain relievers like acetaminophen he says. or from exercise and physical therapy. ORTHOVISC® is not for use in people with known allergy to hyaluronate preparations, to gram bacterial proteins, with infections or skin diseases in the area of the injection site or joint. Common side effects include joint pain, back pain, headaches and pain or redness at the injection site. All three Pettrone physicians – Frank, Sarah and Kristen – ORTHOVISC® is manufactured by and is a registered trademark volunteer their time and expertise on medical missions around of Anika Therapeutics, Inc. the world. Sarah and Kristen traveled together to Bhutan, an isolated mountain kingdom located high in the Himalayas, and the sisters plan to go on a mission to Ethiopia later this year. Sarah may have followed in her father’s footsteps, but Frank Pettrone knows his daughter stands on her own two feet. “To see someone as smart and active as Sarah, who is hard working and well respected, succeed beyond anyone’s dreams is an amazing feeling,” he says. “Around here, Sarah used to be known as Frank’s daughter. Now, I am Sarah’s dad.” Frank A. Pettrone, MD, earned a BA from Brown University and a medical degree from Georgetown University. Dr. Pettrone completed both his internship and residency LAMBERT, RIDDLE program at Georgetown University Medical Center. Then, before joining Commonwealth SCHIMMEL & COMPANY Orthopaedics, he served a tour in the United (Established 1917) States Navy as an orthopaedic surgeon. Sarah Pettrone, MD, graduated summa cum Serving the Business and Personal Insurance laude from the University of Notre Dame Needs of Northern Virginia for Over 90 Years with a BS in Biology and earned her medical degree from the University of Virginia School of Medicine. Dr. Pettrone completed an omas P. Schimmel, C.P.C.U. & James D. Riddle orthopaedic surgery internship and residency Partners at New York University-Hospital for Joint Diseases as well as a hand fellowship at the University of Washington in Seattle. (703) 691-1300 3931 UNIVERSITY DRIVE FAIRFAX, VIRGINIA 22030 tom@LRSCINS.com jim@LRSCINS.com Commonwealth Orthopaedics | www.c-o-r.com 7 Treating a Pain in the Neck Advanced Care for Cervical Spine Conditions W hen Hayley’s right arm began to hurt several years and held together with metal plates and screws. Following ago, she wasn’t sure what was wrong. The 48-year- surgery, the body begins its natural healing process and new old Springfield mother stopped playing tennis and bone cells are formed around the graft.” wore a wrist brace, but the pain only intensified. Eventually, she came to Commonwealth Orthopaedics for steroid injections two of the biggest surgical advancements that and physical therapy. Although the treatments didn’t stop the Commonwealth offers are bone graft substitute pain, they did reveal a surprising fact about its source: it was coming from her neck. and high-tech instrumentation. Hayley consulted Commonwealth surgeon Thomas Mazahery, “Instead of taking bone from the patient or using an allograft MD, who has a special interest in treating conditions of the from a cadaver, as we did in the past, we now use man-made cervical spine. Sure enough, an MRI showed two severely plastic, ceramic, or bioresorbable compounds. This material ruptured discs in her neck compressing nearby nerves. Dr. is packed with shavings of living bone tissue inside a cage,” Mazahery recommended she have surgery right away. explains Edward Lane, MD, a Commonwealth physician who performs spine surgery and many other orthopaedic “Patients with this condition, known as cervical radiculopathy, procedures. “Coupled with the newest minimally invasive typically feel pain that radiates from their neck into their surgical instruments and high-tech surgical microscopes, it shoulder blade, down their arm and possibly into their hand,” makes surgery much easier on our patients. They experience far he says. “It can affect any age group, from those in their late less pain and blood loss, fewer complications, and a significantly teens and early 20s to people in their 70s and 80s. Younger faster recovery.” patients usually have a soft disc herniation, while older ones have arthritic or degenerative changes that create bone spurs Hayley’s anterior cervical discectomy and fusion provided that dig into the nerves. At Commonwealth, we also see patients instant pain relief and her condition continues to improve. She with a combination of both.” spent one night in the hospital and returned to her job with the Department of the Navy two weeks later. Within six weeks, she The good news is that about 70 to 80% of patients respond to was back to her regular schedule and activities. She is currently conservative treatment. This can include time to see if the nerve working hard to strengthen her arm so she can play tennis again calms down, anti-inflammatory medications, physical therapy later this spring. with traction to take pressure off the nerve, or cortisone shots in the neck. For patients such as Hayley whose pain persists, “My entire Commonwealth experience was positive,” she says. or who have progressive weakness or instability of the spine, “Dr. Mazahery is a great doctor – very down to earth and Commonwealth offers the latest minimally invasive surgical personable. And the surgery was extremely successful. It’s such options. a relief to be rid of the pain, which was making me sad and had changed my life. Now I definitely recommend surgery to others “Anterior cervical discectomy and fusion is the most common in my condition. There’s no reason to live in constant pain.” procedure for cervical radiculopathy,” says Ron Childs, MD, a Commonwealth Orthopaedics spine specialist. “The surgeon makes a small Video Extra! incision in the front of the neck and removes the damaged disc to take pressure off the nerve. The Check out the symptoms and treatment for pinched open disc space is then filled with a bone graft, nerves in the video by Thomas Mazahery, MD which helps the adjacent vertebrae to fuse. The www.c-o-r.com/videos bone graft and vertebrae are often immobilized 8 Commonwealth Orthopaedics | www.c-o-r.com Ronald C. Childs, MD, earned a BA in Psychobiology from Boston University before going on to complete his medical degree and orthopaedic surgery residency at Howard University. Dr. Childs then pursued additional training in Chicago where he completed a spine surgery fellowship program at Rush- Presbyterian—St. Luke’s Medical Center. H. Edward Lane, III, MD, earned his medical degree from Georgetown University School of Medicine in Washington, DC. He then completed his internship and orthopaedic surgery residency at Georgetown University Medical Center. Thomas Mazahery, MD, received a BA in Biology from the University of Virginia and earned his medical degree from the Medical College of Virginia. He then completed a general surgery internship and an orthopaedic surgery residency at Northwestern University. Additionally, Dr. Mazahery completed a spine fellowship at Case Western Reserve University. 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. For over 20 years PhoneTree and our 1-800-246-1637 products have been www.CustomMedicalMagazine.com TRUSTED Custom Medical Design Group* and is the premiere publisher of custom medical magazines with more than 27 years of publishing experience and PROVEN over 200 medical magazines from to deliver messages coast-to-coast. A beautiful, glossy making practices magazine just like this can be used more efﬁcient and as an excellent way to increase your referrals, educate your patients and PROFESSIONAL. introduce your doctors. Whether you are a large or small practice, we have the experience to create a series of publications that will suit your needs. Don’t Be Left Out—Join Our Ever Growing Gallery of ™ Customers. * Custom Medical Design Group is a division of Custom Publishing Design Group phonetree.com • 800.951.8733 Commonwealth Orthopaedics | www.c-o-r.com 9 Nothing to Fear Safe, Effective Spine Surgery Helps Relieve Low Back Pain F aced with the prospect of spine surgery, treatment, acupuncture, yoga and Pilates. If these fail Sandra admits she was scared. The 54-year-old to provide suitable relief, or there is any significant Annandale homemaker had been experiencing weakness or numbness, we recommend surgery. While increasingly severe back pain for several years. When there is a lot of fear in the lay population, surgery is an MRI revealed she had two bulging discs in her lower very safe, very effective, and most people achieve their back, she knew she had to take action. Sandra was desired level of no or minimal pain.” already a Commonwealth Orthopaedics patient for her knees, so she looked at a list of physicians One of the biggest advancements in spine fusion surgery on the Web site and selected spine specialist is the use of bone graft substitute. “We used to take Steven Hughes, MD to treat her back pain. bone from the patient’s hip as part of the procedure,” says Tushar Patel, a Commonwealth Orthopaedics spine At her first appointment, Dr. Hughes laid out specialist. “Now we use genetically engineered proteins, the options: Sandra could have surgery or she which stimulate bone growth naturally in the body, or a could try non-surgical treatments to manage ceramic synthetic product such as INFUSE®. As a result, the pain. “At that point, my attitude was there’s much less pain and blood loss, and recovery is ‘anything but surgery,’” she recalls. “I was significantly faster because we no longer harvest bone quite fearful and tried to convince myself directly from the patient.” my back pain wasn’t all that bad. Dr. Hughes was very understanding and didn’t pressure Other advancements that Commonwealth offers include me at all. He let me make the decision and the minimally invasive TLIF and XLIF procedures. I chose the non-surgical route.” During TLIF (transforaminal lumbar interbody fusion), surgeons approach the spine from the side of the spinal Sandra tried medication, physical canal through a midline incision in the patient’s back, therapy and steroid injections, to sparing nerves and muscles. XLIF (extreme lateral no avail. When the pain became so interbody fusion) is performed through the patient’s excruciating she had trouble standing, side, avoiding the major muscles of the back. bending and doing housework, Dr. Patel cautions that minimally invasive spine fusion dr. Hughes sent her for targeted surgery is not for everyone. “The circumstances epidural steroid injections using x-ray surrounding each case are different, so we must evaluate guidance. the x-rays revealed she had patients carefully, as individuals, to determine the several spinal cysts and one of them best course of action. In many cases, surgery is not had ruptured. indicated. In others, traditional open spinal fusion produces results that are as good as, or better, than the That discovery, along with the less invasive alternative. Obtaining a successful result knowledge that her worsening knee depends on a host of factors, and patients should discuss problems would eventually require these thoroughly with a qualified spine surgeon before replacement surgery, forced Sandra to overcome her fears and have back surgery. Dr. Hughes performed a minimally invasive fusion of her lumbar Video Extra! spine. As he explains, her course of Dr. Hughes explains How to treatment is typical for patients with low Diagnose & Treat Back Pain in back pain. “We often try non-operative a special video feature at measures first, such as physical therapy, www.c-o-r.com/videos non-steroidal drugs, injections, chiropractic 10 Commonwealth Orthopaedics | www.c-o-r.com making any decisions.” Sandra is now pain free and had such a positive experience she has since sent her son, husband, and mother to Dr. Hughes for surgery. “My family and I cannot speak highly enough about the wonderful care we’ve received from Dr. Hughes and Commonwealth Orthopaedics,” she says. “My only regret is that I didn’t have surgery sooner. I would have spared myself so much pain and effort, and maybe done less damage. If I could say just one thing to others in my situation, it is this: don’t let your fear stop you from getting the help you need.” Steven S. Hughes, MD, graduated summa cum laude from the University of Rochester and completed his medical degree with honors from the University of Rochester School of Medicine. Dr. Hughes worked as a surgical intern at Bethesda Naval Hospital and was later honorably discharged after serving as a Commander in the United States Navy. Following his internship, he completed an orthopaedic surgery residency at Strong Memorial Hospital in Rochester and a fellowship in spinal surgery at Case Western Reserve Hospital. Tushar Ch. Patel, MD, earned his medical degree from the University of Pennsylvania in Philadelphia and completed his orthopaedic surgery residency at George Washington University Medical Center. He then went on to do a fellowship in Spinal Surgery at the Cleveland Clinic Foundation in “The XLIF procedure Lisa – Centreville Cleveland, Ohio. really changed my life. XLIF Spine Surgery For full biographies and a complete directory of I feel like I can get back to the physicians at Commonwealth Orthopaedics my life, and I am so glad to who perform these and other procedures visit our website at www.c-o-r.com. be able to do that.” Commonwealth Orthopaedics | www.c-o-r.com 11 Targeted Relief For Low Back Pain L ow back pain is one of the most common medical conditions, affecting more than 80 percent of American adults at some point in their lives. The low back is vulnerable to many pain- provoking disorders, ranging from simple strains to herniated discs, degenerative disc disease, or spinal stenosis (narrowing of the spinal canal). Certain conditions can also cause radicular pain – burning, numbing or tingling that radiates down the leg due to a compressed or inflamed nerve. “I had three shots over a At Commonwealth Orthopaedics, epidural steroid injections (ESI) period of six weeks… are an effective treatment option for many forms of low back and leg Since then, I’ve gotten back pain. This targeted procedure, which deposits a long-lasting steroid directly into the epidural space surrounding the spine, is often used to all my regular activities.” in conjunction with other non-operative measures such as physical therapy to delay or prevent the need for surgery. “ESI is highly effective for patients with disorders of the spine,” says Maureen – Oak Hill Brett Robinson, MD, an anesthesiologist and Commonwealth pain Non-Surgical Pain Management management specialist. “While it is most useful for acute injuries that have occurred within six months, it can also be helpful for longer standing problems.” Brett M. Robinson, MD, a native of New York city, earned a BA in Psychology from Yale In some cases, epidural steroid injections are used after other University before going on to receive his medical methods of pain control have failed. ESI can be more effective degree from Tulane University. He then completed than oral steroids or anti-inflammatory drugs because it delivers a rotational internship and an anesthesiology medication directly to the source of the pain. Physicians use X-ray residency at the University of New Mexico, or contrast dye to better target the area of concern, allowing more Department of Anesthesiology and Critical Care medicine to go where it is needed. Medicine, in Albuquerque, New Mexico. “ESI is used to quiet nerve inflammation and decrease or eliminate Amanda B. Trucksess, MD, graduated cum laude from the College of William and Mary with acute pain associated with conditions such as a herniated disc, a major in kinesiology. She went on to earn her stenosis, or sciatica,” explains Amanda Trucksess, MD, who medical degree from the Virginia Commonwealth specializes in physical medicine and rehabilitation at Commonwealth University School of Medicine at the Medical Orthopaedics. “A specific type of ESI – a transforaminal approach – College of Virginia. Dr. Trucksess completed a can be used as a diagnostic procedure as well in order to localize a four year residency in Physical Medicine and specific nerve root that is the source of a patient’s pain.” Rehabilitation at the University of Virginia. ESI are very simple and safe procedures. They can be done up to For full biographies and a complete directory of the physicians three times in six months, if necessary, with the goal of returning at Commonwealth Orthopaedics who perform these and other procedures visit our website at www.c-o-r.com. patients to their full, pain-free function and activity. 12 Commonwealth Orthopaedics | www.c-o-r.com Commonwealth Orthopaedics in the Community Commonwealth Orthopaedics’ Physicians Speak at The Virginia Youth Soccer Association Convention M ore than 650 people attended the Virginia Youth Soccer Association, Dr. Ben Kittredge presents information on how to prevent (VYSA) annual soccer convention and running injuries. awards luncheon in Crystal City, in January 2011. Soccer coaches, administrators, referees, ATC Workshop parents and players gathered to see coaching demonstrations and attend lecture sessions F or the fifth year in a row, certified athletic trainers to learn how to better serve the players and (ATC's) from Fairfax, Arlington and Loudoun County parents of our soccer community. Public Schools as well as physicians attended a free Physicians from Commonwealth Orthopaedics workshop, "Collaborating Care Between Sports Medicine presented information on common soccer Physicians and Athletic Trainers," on Sat., Feb. 26 at The injuries such as foot and ankle injuries, knee Mason Inn in Fairfax, Va. and ACL injuries, and concussions. ■ “The workshop provided a great opportunity for the certified athletic trainers from local high schools to interact with physicians and other health care providers from Commonwealth Orthopaedics to improve skills, share information and develop a working relationship that will have a positive impact toward the overall health care provided to student athletes,” said Jon Almquist, ATC, FCPS Athletic Training Program Administrator. “At Commonwealth Orthopaedics we are committed to working closely with certified athletic trainers at area high schools. We see them as critical partners in providing student athletes with information about injury prevention and rehabilitation,” said Gordon Avery, President of Commonwealth Orthopaedics. ■ Commonwealth Orthopaedics | www.c-o-r.com 13 Best Foot Forward E njoying a glass of iced tea in his kitchen, Kevin develops. Patients with chronic untreated extensor tendon misjudged the counter height and broke the glass, lacerations have difficulty controlling the toes when attempting sending a razor-sharp shard into his left foot. The jagged to put on socks or shoes; the toe tends to catch on them.” glass lacerated a tendon, covering the floor of his Alexandria Dr. Lutta performed Kevin’s tendon repair four days after the home with blood. When emergency room doctors discovered initial injury. Despite the large open wound and risk of the Kevin couldn’t move one of his toes, the diagnosis was clear: tendon ends retracting, potentially making repair difficult, the he had severed his extensor tendon and would need surgery to surgery was a success. Kevin spent a week on crutches with a repair it immediately. soft cast and then had a walking boot put on so he could return Kevin, 51, consulted Commonwealth Orthopaedics surgeon to work and basic activities. After a month, he came back to Kevin Lutta, MD, who specializes in foot and ankle procedures. Commonwealth for physical therapy, which he continued on “I was apprehensive because I had done enough research his own at home. His pain was minimal, his recovery rapid, and to know that tendon reattachment is tricky and I wanted an he has since returned to all the things he loves – golfing, biking, experienced surgeon to perform the operation,” Kevin recalls. and working out in the gym. “Dr. Lutta put me at ease right away. He had a great disposition “I feel great and I’m very pleased with the care I received at and reassured me that he had done this type of surgery many Commonwealth Orthopaedics,” he says. “I wholeheartedly times before.” recommend the entire team, especially Dr. Lutta. He’s a pro Treatment of extensor tendon injuries varies depending on who does a tremendous job and I’m a living, breathing – and whether the injury is a laceration, like Kevin’s, or a rupture. walking – example of that.” The first step is a careful physical examination to evaluate the specific extensor tendon involved, especially in lacerations Kevin Lutta, MD graduated with a BA in where multiple tendons and other structures such as nerves Biology from Clark University. He earned and blood vessels may be damaged as well. These, too, may his medical degree from Howard University College of Medicine, where he was named to need to be repaired. Alpha Omega Alpha Medical Honor Society. He completed his residency in orthopaedic surgery Commonwealth Orthopaedics’ experienced surgeons offer the at Howard University Hospital and went on most advanced repair techniques available. “Extensor tendons to a fellowship in foot and ankle reconstruction at Pennsylvania in the foot are relatively superficial and easily lacerated with Hospital, part of the University of Pennsylvania Health System. trauma,” Dr. Lutta explains. “In these cases, surgery is the best treatment option. The goal is to restore extension function For full biographies and a complete directory of the physicians to the lesser toes. It has been shown that when the extensor at Commonwealth Orthopaedics who perform these and other procedures visit our website at www.c-o-r.com. tendons are transected and not repaired, a claw toe deformity www.c-o-r.com 14 Commonwealth Orthopaedics | www.c-o-r.com After severing his extensor tendon in his foot, Kevin had surgery to reattach the tendon Kevin – Alexandria and recovered rapidly so he can Lacerated Extensor Tendon Repair enjoy his golf game again. Commonwealth Orthopaedics | www.c-o-r.com 15 Going the Distance Minimally invasive arthroscopic hip surgery allowed Laurie to get back to what she loves— competing in triathlons and training women for all types of endurance events. Laurie – Potomac Falls Minimally Invasive Hip Arthoscopy 16 Commonwealth Orthopaedics | www.c-o-r.com C ompeting in an Ironman® triathlon is a pipe dream Surgical candidates include anyone for whom non-operative for most of us. For Laurie, it’s all in a day’s work. treatment such as pain medication, steroid injections or The 40-year-old USA Triathlon-Certified Coach physical therapy has failed, except those with advanced and mother of two is the founder of Amaiza Fitness. Amaiza arthritis. Fitness’ tri4women program trains women to compete in triathlons and other endurance events. She is also a One of the biggest benefits of hip arthroplasty is faster competitive triathlete and runner herself. But when nagging recovery time. Most patients can begin light activities such hip pain spread to her back and leg, Laurie was forced to hang as biking or swimming within a few weeks. Laurie was home up her wetsuit, bike and running shoes, and watch her beloved one hour after waking up from her surgery. She had minimal triathlon races from the sidelines. pain, and was able to walk with a crutch. A few days later she was swimming, and soon she returned to a stationary bike to “The situation was really frustrating, and I spent a year stay in shape. Four months after her surgery, she was running trying all sorts of non-operative remedies to get rid of the again. pain,” she says. “I saw lots of doctors, had lots of tests, went to a chiropractor, tried massage, but nothing really worked.” “I had such great results and Dr. Parker was awesome,” she Finally, an MRI with contrast showed the bone needed to be says. “He’s one of the leading physicians doing this procedure shaved down. A friend recommended she consult Andrew in the area and he’s done it lots of times, so I felt very confident Parker, MD, a Commonwealth Orthopaedics surgeon with about everything. He was available whenever I needed to talk, special interest and experience in hip arthroscopy. and he always encouraged me to make my own decisions. He’d say, ‘If you were my sister, this is what I’d recommend,’ but he Dr. Parker offered Laurie two choices. She could have a never made the choice for me.” relatively simple procedure to clean up the cartilage in her hip, or more complex surgery to also shave the bone. The latter Laurie also praised Commonwealth’s Outpatient Surgery would require a longer recovery before she could return to Center, which she found more comfortable and personable running and competing, but the results would be permanent. than a hospital. She was in and out fast, without a lot of Laurie didn’t hesitate, telling Dr. Parker, “Get me in ASAP so I waiting time, and felt at ease with the attentive, one-on-one can get on with my life.” Last June, she had minimally invasive care from the staff. arthroscopic hip surgery at Commonwealth’s Outpatient Her hip pain is gone and her range of motion is back in full. Surgery Center in Herndon. Just eight months after her surgery, she will compete in the Arthroscopic techniques have revolutionized 2011 Rohto Ironman 70.3 California – a race that consists of hip surgery. Historically, physicians had to cut through a 1.2-mile swim, a 56-mile bike ride and a 13.1-mile run. She connective tissue and dislocate the joint to find and correct will follow that up with a full Ironman – a 2.4 mile swim, 112- the problem. Now, they make a tiny incision and insert a mile bike ride and 26.2-mile run – in Lake Placid, NY. “My pencil-sized optical device (called an arthroscope) with a recovery from surgery was amazingly quick and I was back to video camera attached, which transmits magnified images of normal very fast,” she says. “People shouldn’t hesitate to have the inside of the joint to a TV monitor. Guided by the images, this done.” surgeons use miniature instruments to perform the procedure. D. Andrew Parker, MD earned a BS in Biology “Hip arthroscopy allows us to repair and restore the and Chemistry from Wake Forest University. Dr. normal anatomy of the hip joint in a minimally invasive Parker then graduated magna cum laude from fashion, thereby allowing patients to return to everyday medical school at the University of Louisville. life, recreation and sports much more quickly,” explains Dr. He completed his internship and residency in Parker. “Commonwealth offers the latest minimally invasive orthopaedic surgery at Northwestern University. techniques for hip arthroscopy to treat conditions such as Dr. Parker concluded his formal medical labral tears, traumatic cartilage injuries, early osteoarthritis education by completing a fellowship in sports medicine at the and femoroacetabular impingement, which occurs when Baylor Sports Medicine Institute in Houston, Texas. the head of the femur does not have full range of motion within the socket. In fact, arthroscopic procedures to treat For full biographies and a complete directory of the physicians femoroacetabular impingement may remove a major risk at Commonwealth Orthopaedics who perform these and other procedures visit our website at www.c-o-r.com. factor in the development of osteoarthritis.” Commonwealth Orthopaedics | www.c-o-r.com 17 “I was very motivated to get back to my previous activities and lifestyle and I couldn’t have done it without Dr. Lawhorn.” Mary – Herndon ACL Reconstruction and Meniscus Transport 18 Commonwealth Orthopaedics | www.c-o-r.com Complex Knee Surgeries Restore High-Velocity Lifestyle RESTORING CARTILAGE H New treatment methods offer options for urtling down the most difficult double black “Mary had a large, traumatic isolated defect of her articular patients with knee damage diamond ski slopes doesn’t faze Mary, but when cartilage, the connective tissue that covers the knee joint,” Dr. By D. Andrew Parker, MD Lawhorn explains. “To undergo ACI, it was imperative she she faced a series of technically demanding knee surgeries, she was grateful to have one of the most have an intact ACL and stable knee, reasonable remaining meniscus function to minimize the compressive forces on experienced orthopaedic surgeons to perform them. last decade, a number of highly tech- commonly injured knee ligament. Collisions on During the her articular cartilage, and normal alignment snapping or nological options for treating patients with carti- the field sometimes twist the knee, of the knee lage damage freak Mary, who is in her late 40s, had injured her knee in a have developed. They add to a tearing the ACL. and leg.” accident at an exercise boot camp near hergrowing spectrum of choices for treatment. Herndon home. One in six people with an ACL injury also has an Subsequent diagnostic tests and procedures revealed a host First, Dr. Lawhorn performed an ACL reconstruction to Injuries to the Knee injury in another ligament or in the meniscus, a of problems: an acute ACL tear, a complete radial split of her defined harvest the cells for her cartilage strengthen her knee and pad of knee cartilage known as fibrocar- In damage. regeneration surgery. He later performed the medial medial meniscus, and a large area of cartilage general, younger patients sustain knee carti- tilage that fills the space where the femur (thigh- lage damage from a traumatic event, while older bone) and the tibia (shinbone) meet. And closer meniscus transplant and ACI – two lengthy, complicated She was referred to orthopaedic surgeon Keith Lawhorn, MD, to experience degenera- to the bone is hyaline cartilage, the real shock patients are more likely procedures – at the same time. who determined she needed ACL reconstruction, knee cartilage as a result of osteoarthritis. absorber in the joint. tion of a meniscus But there are many exceptions. transplant, and cartilage regeneration surgery – a technique Damaged meniscal or hyaline cartilage can In a meniscus transplant, fibrocartilagetissue from a donor cadaver is symp- cause significant pain. Consequently, when we known as autologous chondrocyte implantation (ACI). This may have earlysize-matched and transplanted into the knee using Athletes use the flex and strength of A 40-year-old runner the knee to compete, and they depend toms of osteoarthritis. the same time, he treat a patient with a knee injury, cartilage two-part procedure involves harvesting the patient’s own At an arthroscopic-assisted, mini-open approach. Because the cartilage cells on kneegrowing the— theinbuffer of mayand injecting cartilage, a laboratory, experience a knee injury that damages restoration is often part of the protocol. operation is technically challenging and requires months of tissue between articulating surfaces — to do so cartilage as well as other structures, most area. them back into the damaged elastic, spring- typically ligaments. without pain. Healthy cartilage is post-operative rehabilitation, meticulous and appropriate Cartilage Implantation ing back in response to pressure. When chon- patient selection is critical for success. “This procedure drocytes, or cartilage cells, are damaged, friction Football fans certainly have heard of the anterior Swedish researchers were able to culture hyaline Continued on page 20 builds and pain is sometimes severe. cruciate ligament (ACL), which is the most cartilage cells outside the body for the first time Five Steps of Carticel 1. 2. 3. 4. 5. 1. An initial biopsy of normal joint surface is removed from the non–weight-bearing portion of the knee. 2. The biopsy is sent to a Genzyme lab, where it is cultured and grown into a solution of the patient’s cartilage cells. 3. During the second procedure, the sur- geon makes an incision in the knee and removes any damaged cartilage. 4. A piece of lining is then removed from the adjacent upper tibia bone and sewn over the defect. 5. This creates a water-tight membrane to contain the cultured cartilage cells. The patient’s cells are then injected into the defect. Images courtesy of Genzyme Corporation. 8 Commonwealth Orthopaedics Commonwealth Orthopaedics | www.c-o-r.com 19 Complex Knee Surgeries - continued from page 19 In Memoriam is typically reserved for patients under 40, but can be considered in patients up to 50 if they are highly active and have minimal arthritic changes,” says Christopher Annunziata, MD, who performs these complex surgeries at Commonwealth Orthopaedics. “It should be used only after exhausting all nonsurgical measures, except in cases where there is concomitant ACL and medial meniscus deficiency with significant rotational instability that may compromise success of ACL reconstruction alone.” With the right patient, meniscus transplant and ACI performed together rather than separately can significantly improve outcomes in the most difficult cases. Following her surgeries, Mary spent two days in the hospital and returned home for an intensive, year-long rehabilitation. During the first two months, she used crutches and built up her strength on a continuous passive motion (CPM) machine. She began walking again at 10 weeks and spent another 10 months in physical therapy at Commonwealth Orthopaedics. One month later she went hiking in the Great Smoky Mountains, and a few months after that she was finally back on the black diamond ski slopes she loves so much. Charles R. Ubelhart, MD “I was very motivated to get back to my previous activities Caring, Expert Orthopaedic Physician and lifestyle – and keep up with my 10-year-old son – and Commonwealth Orthopaedics I couldn’t have done it without Dr. Lawhorn,” she says. “He 1999-2011 went above and beyond and did an amazing job. He is so technically gifted. My pain is gone and my scar is so small you can barely see it; everything looks fabulous. Now I recommend him to others all the time.” Christopher C. Annunziata, MD, earned Keith W. Lawhorn, MD, graduated with a BA a BS from Boston College before graduating in Chemistry from the University of Virginia with his medical degree from Georgetown and continued his education at the University University. He completed an orthopaedic of Virginia School of Medicine, where he earned surgery residency at Georgetown University his medical degree . He completed a general Medical Center and went on to complete surgery internship and orthopaedic residency at a fellowship in Sports Medicine/Knee the Medical College of Virginia. Dr. Lawhorn and Shoulder Surgery at the University of served on active duty in the U.S. Air Force for Pittsburgh Sports Medicine Center. eight years, reaching the rank of Lt. Colonel. 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. 20 Commonwealth Orthopaedics | www.c-o-r.com Custom Orthotics and Announcing New Products for Foot Products for Patients Our Foot and Ankle Patients Commonwealth Orthopaedics now offers custom foot orthotics and Commonwealth Orthopaedics now offers custom foot braces for patients. To make an appointment with Dr. Kevin Lutta, our foot orthotics and braces for patients. For more information or to and ankle specialist, please call the Herndon office at 703-810-5204 or make an appointment with Dr. Kevin Lutta, our foot and ankle the Tysons office at 703-810-5225. specialist, please call the Herndon office at 703-810-5204. New Online Store for Foot and Ankle Medical Products Advertiser Directory foot problems, please visit our new online store at For other medical products for your www.c-o-r.com/onlinestore. ...................................................................................9 Kwik Kopy Printing Act College OrthoCare................................................ inside front cover 605 Carlisle Dr. Breg, Inc....................................................... inside front cover Phone Tree ....................................................................................9 Herndon, VA 20170 (703) 435-5502 Brent Associates, Inc............................................back cover Professional Risk Associates.................................................5 (703) 435-8194 Fax DePuy Mitek ................................................................................7 Sterling Services, Inc.................................................................9 RND Softech Diagnostic Health Center ................. inside front cover Supreme Orthopedic Systems .....................back cover US: (561) 208-0006 US: (800) 650-0460 Gates, Moore & Co. ............................................back cover The Washington Group ......................................................21 India: 91-422-325-8078 Lambert, Riddle, Schimmel & Company......................7 West Financial Services, Inc. ............................................21 www.rndsoftech.com Nascott Rehabilitation Services..... inside front cover A Recognized Leader in Wealth Management A Local Expert Financial Advisor A Local Expert Financial Advisor Northern Virginia Magazine - April 2009 Recognized Northern Virginia Magazine - April 2009 Recognized Top Wealth Manager Leader in Wealth Manager Top Wealth Manager Magazine - July 2010 Timothy Danehower, CLU Timothy Danehower, CLU Leader in Wealth Manager Magazine - July 2010 Wealth Top 150 Best Financial Advisors Wealth for 150 Best TopDoctors Financial Advisors Management for Doctors Economics - November 2009 Medical Employee Beneﬁts Management Medical Economics - November 2009 Insurance & Investment Planning 10600 Arrowhead Drive Suite 190 Employee Benefits Since 1982, West Financial Services’ Fairfax,Virginia 22030 Insurance & Investment Planning Since 1982, West Financial Services’ commitment to quality, discipline and (703) 218-4015 owhead Drive Suite 190 Management Risk Employee Benefits Risk Management commitment to quality, discipline and the personal service has made us one of firstname.lastname@example.org rginia 22030 Insurance & Investment Planning most respected has made us one of the personal servicefinancial advisory firms 4015 Risk Management most respected financial advisory firms in the Washington metropolitan area. email@example.com in the Washington metropolitan area. WEST FINANCIAL SERVICES, INC. A Sandy Spring SERVICES WEST FINANCIAL Bank Company , INC. 10600 Arrowhead Drive Suite 190 A Sandy Spring Bank Company Fairfax, Virginia 22030 Investment Management WEALTH MANAGEMENT 1355 Beverly Road, Suite 250 Investment Management Executive & Business WEALTH MANAGEMENT Beverly VA 22101 1355 McLean,Road, Suite 250 (703) 218-4015 Consulting Executive & Business McLean, VA 22101 tdanehower@ﬁnsvcs.com Consulting Comprehensive Financial 703-847-2500 Planning Comprehensive Financial 703-847-2500 www.westfinancial.com Planning www.westfinancial.com Herndon Office • 13350 Franklin Farm Road, Suite 220 • Herndon,VA 20171 • 703-810-5204 21 Commonwealth Orthopaedics | www.c-o-r.com Keeping Patients Informed & Educated C ommonwealth is committed to keeping our patients and community updated on the latest orthopaedic advancements. Here’s how we are communicating: ● The new Commonwealth Orthopaedics blog (http://blog.c-o-r.com) features information and advice from our physicians about orthopaedic conditions, innovative treatments, videos, surgical animations, and more. ● Commonwealth Orthopaedics is on Facebook! Patients can now stay connected to the most current Commonwealth Orthopaedics news and share it with family and friends. ● Every two months, our patients receive an e-newsletter with timely items about orthopaedic care.You can sign up to receive this e-newsletter on our website home page at www.c-o-r.com ■ Outpatient Surgery Rockstar Run Raises Centers Reach Scholarship Funds Milestone M ore than 500 runners and walkers participated in C the second annual Rockstar 8K Run and one mile ommonwealth Orthopaedics’ Outpatient fun run on April 10, 2011. The event raises money Surgery Centers achieved a milestone for the Celebrate Cherie Scholarship Fund established when in 2010: 30,000 surgeries have been Cherie Yadao, a Commonwealth Orthopaedics physical performed at these state-of-the art facilities since therapist and manager, died of a rare cancer in 2009. ■ they opened in 1999 (Herndon) and 2001 (Fairfax). As the only outpatient surgery centers dedicated exclusively to orthopaedics in the region, they offer patients many advantages over a hospital setting including comfort, convenience, personalized one- on-one care, and fewer delays and disruptions. Quality and safety are never compromised. The centers are accredited by The Joint Commission, which means they are held to the same high standards as a hospital. For more information about our outpatient surgery centers go to www.c-o-r. com/outpatientsurgery. ■ 22 Commonwealth Orthopaedics | www.c-o-r.com Meet Our Physicians George Aguiar, MD Christopher C. Annunziata, MD Gordon L. Avery, MD Anne M. Bielamowicz, MD Ronald C. Childs, MD Nancy R. Couleman, MD Reston, Herndon Arlington, Tysons Corner Arlington, Tysons Corner Outpatient Surgery Centers Fairfax Outpatient Surgery Centers Alexander S. Croog, MD Allen G. DeLaney, MD Robert M. Dombrowski, MD J. Mark Evans, MD Mark C. Hartley, MD Steven S. Hughes, MD Fairfax, Fair Oaks Outpatient Surgery Centers Fairfax, Fair Oaks Fairfax Reston Alexandria, Tysons Corner Ben W. Kittredge, IV, MD Thomas J. Klein, MD H. Edward Lane, III, MD Keith Lawhorn, MD Charles S. Lefton, MD Kevin C. Lutta MD Alexandria, Springfield Reston Fairfax, Fair Oaks Fair Oaks Arlington, Tysons Corner Herndon, Tysons Corner Mark P. Madden, MD Thomas A. Martinelli, MD B. Thomas Mazahery, MD John P. McConnell, MD Mark R. McMahon, MD David J. Novak, MD Reston Alexandria, Springfield Reston, Springfield Arlington, Tysons Corner Fair Oaks Fairfax, Fair Oaks D. Andrew Parker, MD Tushar Ch. Patel, MD Frank A. Pettrone, MD Sarah Pettrone, MD Brett M. Robinson, MD David W. Romness, MD Reston Fairfax, Fair Oaks Arlington, Tysons Corner Reston, Tysons Corner Outpatient Surgery Centers Arlington, Tysons Corner Kevin D. Sumida, MD Daniel E. Thompson, MD Amanda B. Trucksess, MD Brantley P. Vitek, Jr., MD Daniel E. Weingold, MD Young J. You, MD Bruce S. Zimmer, MD Arlington, Tysons Corner Alexandria, Springfield Reston, Tysons Corner Fairfax, Fair Oaks Burke, Springfield Alexandria, Springfield Burke, Springfield Commonwealth Orthopaedics | www.c-o-r.com 23 Commonwealth Orthopaedics 11240 Waples Mill Rd., Ste. 403 Fairfax, VA 22030 Specializing in Practice Valuations Contact: Barbara J. Grant, CPA, AIBA, CVA (404) 266-9876 www.gatesmoore.com SpeedBridge Ad 7.875x4.875.indd 1 6/21/10 4:26 PM Specializing in: • Medical Assistants • Office Managers • Ophthalmic Techs • Receptionists • Administrators • Med Lab Techs • Secretaries • Consultants • Physical Therapists and • Surgical Posters • LPN’s, RN’s Licensed Assistants • Transcriptionists • Nurse Practitioners • Physicians & Physicians • Bookkeepers • Ultrasounds, X-Ray, CT, Assistants • Insurance Billing & MRI & Nuclear Med Techs • Doctors of Medicine Collection Specialists • Ortho Techs • Medical Sales Confidentiality assured sinCe 1971 (703) 749-2224 • (301) 942-4825 www.brentassociates.com
"Complex Knee Surgeries"