Total Knee Replacement Outcomes Affected by Smoking
Listen up smokers, at this year’s Annual Meeting of the American Academy of Orthopaedic Surgeons, two studies were presented that showed smoking having an adverse effect on total knee and total hip replacement surgery.
The negative effects of smoking on healing have been known and reported for quite some time. These include transfusion, cardiac issues, infection, increase incidences of bone healing problems such as mal-union and non-union, delays to desirable callus formation and higher occurrences of soft tissue healing complications. It is surmised that these problems are caused by the increase vasoconstrictive effect that smoking has on the blood vessels.
Total knee replacements in high volume hospitals were studied by researchers and it was determined that smoking elevated the revision rates and other complications following surgery compared with non-smokers. Give up the smokes prior to surgery was the recommendation that emerged from this study.
Researchers studying a newer material known as ultraporous metal for total hip replacements were forced to conclude that smoking significantly increased the failure rate when using this material (11%) compared to non-smokers (3.8%) and former smokers (5.3%). Previous studies had shown increase survivorship with this product and researchers had hoped that this effect would carry over to the smoking population.
A Smoking Cessation Forum was held at the American Academy of Orthopeadic Surgeon conference as well and suggestions were made that surgeons refuse to perform surgery on smokers to help ensure optimal care; advise smoking patients to stop and offering resources to help or finally to specifically offer smoking cessation assistance.
Interestingly, medscape published an online abstract on July 8, 2011 from Arthritis Rheum that determined that smoking is inversely proportional with the risk for having a total knee replacement. This means that the more you smoke the less likely you are to have your knee replaced. This inverse relationship might have to do with the tendency of smoking to inhibit weight gain but no hard and fast answers exist yet. So in conclusion, you are less likely to have your knee replaced if you smoke and more likely to have complications if you do in fact need to do the surgery. But could there be something else lurking?
“Smoking is the most costly and most preventable risk factor in postoperative complications.” stated Dr Warner, MD at the Smoking Cessation Forum. “Surgery is a teachable moment-and we need to capitalize on it.” he followed. Dr Warner is the dean of Clinical and Translational Science at the Mayo Clinic. Smoker beware. If it is up to the dean, you may not have as many options in the future should you need to have your knee replaced. I’m still trying to find out what in the heck translational science is. You might have been wondering as well. I did find out that a considerable amount of your tax dollars are being used to fund research under this name and create translational science centers. Humm. Stay tuned for more information. Yours in Health.