Common modifiable risk factors in total joint arthroplasty: a 2021 update—smoking

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  • Recent publications on outcomes after primary total joint arthroplasty
  • Is there a difference between heavy smokers versus light smokers?
  • Variations in the definition of smoking status
  • Quitting smoking: better late than never

Part 1 | Diabetes

Part 2 | Obesity

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Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):

Matthew P Abdel

Mayo Clinic
Rochester, United States

Steven MacDonald

University of Western Ontario
London, Canada

Michael A Mont

Rubin Institute for Advanced Orthopedics
Baltimore, United States

This article was compiled by Maio Chen, Senior Project Manager Medical Writing, AO Foundation, Switzerland.

References

  1. Porter SE, Hanley EN. The Musculoskeletal Effects of Smoking. JAAOS – Journal of the American Academy of Orthopaedic Surgeons. 2001;9(1):9–17.
  2. Bojan B, Perni S, Prokopovich P. Systematic Review and Meta-Analysis of Tobacco Use as a Risk Factor for Prosthetic Joint Infection After Total Hip Replacement. Arthroplast Today. 2020 Dec;6(4):959–971.
  3. Matharu GS, Mouchti S, Twigg S, et al. The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients. Acta Orthop. 2019 Dec;90(6):559–567.
  4. Tischler EH, Matsen Ko L, Chen AF, et al. Smoking Increases the Rate of Reoperation for Infection within 90 Days After Primary Total Joint Arthroplasty. J Bone Joint Surg Am. 2017 Feb 15;99(4):295–304.
  5. Khan LA, Cowie JG, Ballantyne JA, et al. The complication rate and medium-term functional outcome after total hip replacement in smokers. Hip Int. 2009 Jan-Mar;19(1):47–51.
  6. Peersman G, Laskin R, Davis J, et al. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001 Nov(392):15–23.
  7. Singh JA. Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol. 2011 Sep;38(9):1824–1834.
  8. Bedard NA, DeMik DE, Owens JM, et al. Tobacco Use and Risk of Wound Complications and Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis of Primary Total Joint Arthroplasty Procedures. J Arthroplasty. 2019 Feb;34(2):385–396.e384.
  9. Singh JA, Schleck C, Harmsen WS, et al. Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study. BMC Med. 2015 Nov 19;13:283.
  10. Duchman KR, Gao Y, Pugely AJ, et al. The Effect of Smoking on Short-Term Complications Following Total Hip and Knee Arthroplasty. J Bone Joint Surg Am. 2015 Jul 1;97(13):1049–1058.
  11. Sahota S, Lovecchio F, Harold RE, et al. The Effect of Smoking on Thirty-Day Postoperative Complications After Total Joint Arthroplasty: A Propensity Score-Matched Analysis. J Arthroplasty. 2018 Jan;33(1):30–35.
  12. Bedard NA, Dowdle SB, Owens JM, et al. What is the Impact of Smoking on Revision Total Hip Arthroplasty? J Arthroplasty. 2018 Jul;33(7s):S182–s185.
  13. Bedard NA, Dowdle SB, Wilkinson BG, et al. What is the Impact of Smoking on Revision Total Knee Arthroplasty? J Arthroplasty. 2018 Jul;33(7s):S172–s176.
  14. Møller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002 Jan 12;359(9301):114–117.
  15. Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014 Mar 27;2014(3):Cd002294.
  16. Hamilton WG. No Smoking Allowed: Is the Operating Room the Next Place That Smoking Patients Undergoing Total Joint Arthroplasty Will Be Banned?: Commentary on an article by Eric H Tischler, BA, et al.: “Smoking Increases the Rate of Reoperation for Infection within 90 Days After Primary Total Joint Arthroplasty”. J Bone Joint Surg Am. 2017 Feb 15;99(4):e17.