A systematic review assessing the effects of smoking on outcomes of total joint replacements suggests that the habit not only increases the risk of overall post-op complications, but also enhances the chances of developing post-op complications after an arthroplasty, a previously unknown finding.

The Data Says It All

Jasvinder Singh, MD, MPH, Professor of Medicine at UAB Division of Clinical Immunology and his team analyzed data obtained from an institutional Total Joint Registry. Of the 7,926 patients who underwent hip or knee arthroplasty, seven percent were tobacco users.

It was seen that in comparison to current non-tobacco users, current users had higher hazard ratios (95% CI) for developing deep infection, 2.37 (1.19, 4.72; p=0.01) and implant revision, 1.78 (1.01, 3.13; p=0.04) after undergoing total hip or knee arthroplasty. No significant differences were observed periprosthetic fractures or superficial infections.

What Physicians Must Suggest

These findings suggest that the use of tobacco must be ceased before undergoing elective knee or hip arthroplasty. This will significantly reduce the development of several short-term post-operative complications and the risk of infection. Operation procedures should be delayed or postponed in order to allow patients to temporarily quit smoking.

Moreover, the consent to knee/hip osteoporotic must highlight the increased risk of post-complications who continue to smoke before, during and after the arthroplasty.

Future Prospects: Arthroplasty

Further studies must be performed to assess the optimal time for tobacco cessation before an elective surgery. Furthermore, the underlying mechanisms that improve post-op outcomes must be investigated, especially in relation to arthroplasty.

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