Issue link: https://viewer.e-digitaledition.com/i/556451
success of the revision is directly related to appropriate treatment for that cause. That's where 35 years of experience — or as Dr. Stulberg says, "being around a long time" — makes a difference. "When you're used to dealing with a wide variety of devices, you begin to get a sense of how each device was made, how it was implanted, how it works for a particular patient and how the things that are not working well can be fixed," Dr. Stulberg explains. "If we can resolve the problems non-operatively, we do. If we need to work with the surrounding tissues and tendons, then we do that. If adjusting or removing bone or the device is needed, we do that. If possible, we try to work with implanted parts that are well anchored and can be preserved. Whatever it takes to make sure the result is a well anchored and mechanically sound reconstruction … we do." Dealing with infection in the hip or knee is a more difficult problem for the patient — one that requires a two-stage procedure: the first stage to totally eradicate the infection, and the second to replace the device. "Infection that surrounds foreign materia l w ill not clea r predictably unless you can get rid of the infection on the material," Dr. Stulberg explains. "The safest way to achieve that has been to remove the device completely or very thoroughly clean the device. We work in conjunction with infectious disease experts at St. Vincent's to select the appropriate antibiotics for the causative organism. A temporary device, called a spacer, is often placed into the joint for six to eight weeks to deliver highly concentrated antibiotics and maintain the tissue tension. At the same time, the patient receives IV antibiotics. "This allows us to monitor the control of the infection, and allows the patient to function. But it can take two to three months or more to feel secure that the infection is gone. We then go back during a second operation to remove the temporary device and implant a permanent one," he explains. "While we are investigating doing this in one step, like they do in Europe, it's an evolving experience." Assigning a Team Long before surgery is performed, the patient is assigned a personal care team. This team includes surgeons (St. Vincent's Spine and Orthopedic Institute boasts three highly experi- enced, master surgeons in revision arthroplasty), clinical nurses, physical therapists, nutritionists, social workers and others, all working together to help the patient before, during and after surgery. Marianne Geizer, RN, has worked alongside Dr. Stulberg for more than 20 years. She has both pre-op and post- op responsibilities. "Before surgery we talk about the patient's ex pectations. W hat level of activity they hope to achieve and St. Vincent's Spine and Orthopedic Institute features 21 private suites, each with its own bath, wood and stone flooring, granite surfaces, flat-screen TVs, and executive work stations with high-speed wireless internet access — all overlooking the downtown Cleveland skyline. PHOTO © JOE SMITHBERGER, SMITHBERGER PHOTOGRAPHY, NORTH CANTON SPECI A L FE AT UR E 1 6 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ S E P T E M B E R /O C T O B E R 2 0 1 5