Smokers More Vulnerable to Joint Replacement Failures

Smokers More Vulnerable to Joint Replacement FailuresPeople who smoke cigarettes before and after receiving a total joint replacement, such as a hip replacement device or knee implant, are far more likely to endure revision surgeries on those implants than people who don’t smoke.

Two recent studies presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons showed that smokers were less likely to fully heal following a total joint replacement surgery in which they received either a hip or knee implant. Also, orthopaedic surgeons are more likely to aid in encouraging implant recipients to quit smoking before they are scheduled for surgery to decrease the likelihood of complications after receiving the implant.

For one study, more than 600 patients who received total knee replacement (TKR) implants were analyzed. Among recipients who smoked cigarettes there was a 10-times greater rate of revision surgeries than non-smokers. Failure rates of the TKR were exactly 2-to-1, comparing smokers to non-smokers. Just more than one-fifth of the patients who smoked prior to and after receiving their knee replacement were likely to suffer another form of “medical complication” compared to just over one-tenth of patients who didn’t smoke. Those complications included deep venous thrombosis (DVT) or blood clots, anemia requiring treatment, cardiac problems, and acute renal failure, according to a press release from that conference of the AAOS.

A second study looked at the impact of smoking on patients who received an ultraporous metal acetabular reconstruction surgery, from an implant like the failed DePuy Orthopaedics ASR hip implant, which uses a metal to replace the cup-like connection of the hip joint. These implants have been the source of great speculation in the medical device and joint replacement communities, including the ASR implant which was recalled in August 2010 due to a high failure rate.

The study presented at the AAOS conference found that smokers who received this type of hip implant were three-times more likely to suffer from a device failure than non-smokers, 9 percent to 3 percent.

Overall, patients who didn’t smoke were more likely to endure a total hip or knee replacement without suffering complications, anything ranging from pain and inflammation post-surgery to revision procedures or an eventual early replacement surgery caused by a device failure.

One surgeon from University of South Florida told the conference he has begun refusing to outfit patients who smoke with total knee or hip implants, only agreeing to do so once a patient has quit. This, he said, has resulted in 40 percent of his patients quitting smoking and, in turn, less complications from joint replacement surgeries from procedures he’s performed.

An associate dean for clinical and translational science at Mayo Clinic told the same conference that the moments prior to surgery are an optimal time to encourage would-be recipients of hip and knee implants to quit smoking and that every patient should be encouraged to quit prior to enduring a procedure.

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