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
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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
- Porter SE, Hanley EN. The Musculoskeletal Effects of Smoking. JAAOS – Journal of the American Academy of Orthopaedic Surgeons. 2001;9(1):9–17.
- 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.
- 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.
- 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.
- 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.
- 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.
- Singh JA. Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol. 2011 Sep;38(9):1824–1834.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014 Mar 27;2014(3):Cd002294.
- 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.
