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Smoking and the Risk of Infection After Total Hip and Knee Replacement Surgery

By William P. Barrett, MD on

In a study by Tischler, et al, from the Rothman Institute in Philadelphia, Pennsylvania, patients who were active smokers were found to have a significantly increased risk for infectious complications following hip and knee replacement surgery. In this study, published in The Journal of Bone and Joint Surgery on February 15, 2017, the researchers looked at 15,264 patients who underwent a primary hip or knee replacement between 2000 and 2014 to solidify the relationship between smoking and postoperative infection risk.

Patients were stratified into one of three groups: Current smokers, former smokers, and nonsmokers. The research team looked at patients who had undergone 8,917 hip replacements and 8,477 knee replacements during that period. At the time of surgery, 9% of patients were current smokers, 34% were former smokers, and 57% were nonsmokers. The results showed that current smokers, who tended to need surgery at a younger age than nonsmokers, had an almost doubled risk of reoperation for infectious complications when compared to nonsmokers. After adjusting for other characteristics, current smokers had a relative risk of reoperation within 90 days of the procedure that was 80% higher than nonsmokers. The study also showed that regardless of current smoking status, the amount that one smoked over his or her lifetime significantly contributed to the increased risk of complication. This risk increased depending on how many packs had been smoked per decade.

This is one of many studies that have demonstrated a significant increase in the risk of complication, specifically infection, following joint replacement surgery. As tobacco remains the single largest preventable cause of death and disease in the United States, it is important to identify patients who smoke and have them enter into smoking cessation programs prior to undergoing joint replacement surgery.

Dr. Barrett is an orthopedic surgeon who performs over 500 joint replacement surgeries annually. For more information about total hip and knee replacements, contact Proliance Orthopedic Associates at 425.656.5060.

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