Smoking Increases Complications After Hip or Knee Arthroplasty

Jasvinder Singh MD MPH Professor of Medicine UAB Division of Clinical Immunology and Rheumatology MedicalResearch.com Interview with:
Jasvinder Singh MD MPH
Professor of Medicine
UAB Division of Clinical Immunology and Rheumatology 

Medical Research: What is the background for this study? What are the main findings?

Dr. Singh: A systematic review of the effect of smoking on outcomes after total joint replacement showed that current smoking increased the risk of overall post-operative complications but that there were scarce data for smoking and specific surgical outcomes of arthroplasty. We performed a study using data from an institutional Total Joint Registry to answer this question.   In a study of for 7,926 patients who underwent hip or knee arthroplasty, 7% were current tobacco users. We found that compared to current non-users, current tobacco users had higher hazard ratios (95% CI) for deep infection, 2.37 (1.19, 4.72; p=0.01) and implant revision, 1.78 (1.01, 3.13; p=0.04) after total hip or knee arthroplasty. No significant differences were noted for periprosthetic fractures or superficial infections.

Medical Research: What should clinicians and patients take away from your report?

Dr. Singh: The higher risk of infection and implant revision in our study in conjunction of previously known data that peri-operative smoking cessation decreases the risk of several short-term post-operative complications suggests that peri-operative smoking cessation referrals may be warranted in patients undergoing elective knee or hip arthroplasty.  Whether delaying knee/hip arthroplasty to allow patients to temporarily quit tobacco use should be considered remains to be seen.  The consent process before arthroplasty should explain this increased risk of arthroplasty complications to patients who continue smoking in the peri- and post-arthroplasty period.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Singh: Future studies should determine the optimal time for tobacco use cessation before elective surgeries such as THA/TKA to improve short- and long-term arthroplasty outcomes. Studies should also examine the underlying mechanisms of improved outcomes with tobacco cessation in peri-operative period for patients undergoing arthroplasty.

The higher risk of infection and implant revision suggests that peri-operative smoking cessation referrals may be warranted in patients undergoing elective knee or hip arthroplasty.

Citation:

Perioperative Interventions for Smoking Cessation in Hip and Knee Arthroplasty for Osteoarthritis and Other Non-Traumatic Diseases

Aseem Bharat1 and Jasvinder A. Singh2, 1Medicine/Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 2University of Alabama at Birmingham, Birmingham, AL

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

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Jasvinder Singh MD MPH (2015). Smoking Increases Complications After Hip or Knee Arthroplasty