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Offering Safer Total Joint Replacements at St. Luke’s

Category: Patient Stories
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Dr. David Fogarty, orthopedic surgeon at St. Luke's, is passionate about getting his patients back to doing the activities they love most. 

Imagine living with a constant ache in one of your knees or hips. You wake up stiff, daily activities have become difficult, and a good night’s sleep doesn’t seem to make it any better. After talking with your doctor about your symptoms, you find out that you have arthritis.

You’re offered a few nonsurgical treatment options to help manage your discomfort, but you know these won’t work forever. Your arthritis will continue to progress, and so will your joint pain. You know that eventually you’ll be need a brand new knee or hip through joint replacement surgery.

The orthopedic surgeons at St. Luke’s hear stories like this every day. The Total Joint Replacement program at St. Luke's has earned a Center of Excellence distinction, and the surgical team performs the most joint replacement surgeries in Northern Minnesota. They are constantly improving their care, and through recent changes in the preparation process, St. Luke’s is now able to offer even safer joint replacement surgeries.

Healthier patients, fewer complications
“Overall, joint replacement surgeries are incredibly successful,” explained Dr. David Fogarty, orthopedic surgeon at St. Luke’s. “However, as with any surgery, there is a risk of complications.” In the mind of an orthopedic surgeon, the most concerning complication is infection. If a patient develops an infection after surgery, it can be difficult to manage. It may even affect their ability to fully recover.

Fortunately, there has been increased understanding on how to significantly reduce this risk. Higher infection rates can be strongly connected to several factors of a person’s health. When these factors are improved, the risk of infection drops. These factors include nutrition, weight, tobacco use and alcohol consumption. Getting better control of other chronic health issues such as diabetes, metabolic syndrome and anemia has also led to a lower risk of complications after surgery.

In response to these findings, St. Luke’s has created a list of health requirements that must be met before a person has joint replacement surgery. Alcohol and tobacco use should be able to be stopped for four weeks prior to surgery, a person’s BMI should be below 40, and chronic health issues need to be under control. “We don’t ever tell someone they can’t have the surgery,” said Emily Engstrom, St. Luke’s Orthopedic & Sports Medicine Clinic Manager. “We just postpone things until their health status is at a place where we can move forward safely. These requirements help us objectively know that they are ready.”

Working towards better results together
These requirements are supported by long-term outcome studies and recognized by the orthopedic community nationally. The American Academy of Orthopedic Surgeons as well as the American Association of Hip and Knee Surgeons have published consensus opinions to delay total joint surgery until these aspects of a person’s health can be improved. If patients need assistance to meet these requirements, help is available to them every step of the way.

“We partner with our patients to reach these goals,” explained Dr. Fogarty. “For example, if they need to improve their BMI, we can offer them St. Luke’s Weight Loss Program. If they’re a smoker, we can give them tools to support them in quitting. If their diabetes isn’t under control, their doctor will work with them to improve it.”

For some patients, this change in the preparation process may mean they have to wait to have their operation. However, it also means an increased likelihood of an infection-free recovery. “Ultimately, their surgery will be more successful,” said Engstrom. “They’ll heal more quickly. It will help prevent a readmission. They’ll feel better after surgery than they would have without meeting the requirements.”

Hip and knee replacements at St. Luke’s
Having a standardized list of health requirements for patients before joint replacement surgery is relatively new at St. Luke’s. “Before we left it up to each individual orthopedic surgeon. They each had an idea of how healthy they wanted their patients to be before an operation,” explained Engstrom. “These new guidelines have been collectively put together and agreed on by our whole team. It means better consistency and quality for our patients.”

Positive results have already been noticed from the change. “We’re already seeing reductions in complication rates,” said Dr. Fogarty. “It’s been impressive to see success this early on in the process.”

So, whether joint replacement surgery is a long way off or you’re ready to talk to your doctor soon, know that St. Luke’s offers a team of orthopedic surgeons who constantly strive to put The Patient. Above All Else.

To learn more or schedule an appointment, visit

This article was published in the 2021 January issue of The Woman Today magazine.