Smoking associated with hip and knee replacement failure

Tobacco and nicotine use have been shown to impair the body’s ability to heal bones and wounds. Two new studies presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons looked at the effects of smoking on total joint replacement and found evidence of higher rates of failure compared to non-smokers.

The first study found that patients who smoke before/and or after total knee replacement (TKR) surgery had a higher revision rate compared to non-smokers. The smoking group had a 10 percent knee replacement failure rate compared to the non-smoking group (1 percent). The medical complication rate was also significantly higher in the smoking group with 21 percent of patients having a medical complication compared to 12 percent of non-smokers. Complications included deep venous thrombosis or blood clots, anemia requiring treatment, cardiac problems and acute renal failure.

The second study looked at the effects of smoking on patients who underwent reconstruction of the acetabulum—the cup shaped cavity at the base of the hip bone—with ultraporous metal. Between 1999 and 2009, ultraporous acetabular components were used in 533 hip replacements, including 159 primary and 374 revision surgeries. Of these patients, 17 percent were smokers, 31 percent previous smokers, 50 percent non-smokers, and 3 percent unknown. The failure rate for smokers was 9.1 percent, compared to 3.4 percent for non-smokers.

Presenters recommended that orthopaedic surgeons strongly advocate for smoking cessation before surgery to ensure optimal recovery and outcome.