Current and past smokers face greater risk for hip replacement failure

Smoking has been linked to prolonged healing time and greater risk for complications in orthopaedic and other surgeries, according to a new study presented today at the 2013 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Researchers reviewed records of all total hip replacement (THR, or total hip arthroplasty) patients between 2007 and 2009 to identify patients who used tobacco products at the time of surgery, or who smoked regularly prior to surgery.

There were 110 patients who regularly smoked, with a mean age of 55 and a mean follow up of 46 months following THR. A control group was matched 2:1 with the smoking group based on gender, date of surgery within six months, age within five years, related medical conditions (co-morbidities) and immunosuppressive conditions. The smoking group was categorized as current or former smokers, and according to the number of packs of cigarettes smoked per year.

At the most recent follow up, the patients who smoked had a 92 percent survival rate compared to 99 percent for non smokers. Of the nine THR revisions in smokers, four were done to alleviate pain and/or to repair a loose acetabular component (the hip socket), and five resulted from infection. Of the current smokers, six of 65 had revisions (9.2 percent); of the former smokers, 2 out of 45 patients (4.4 percent).

Overall, the patients who smoked had a higher overall revision rate and a higher incidence of other complications. The study authors recommend smoking cessation programs for all patients considering THR.