Study: Smoking Raises Risk of Additional TJA Surgery

Add infection and additional surgery to the already long list of reasons to quit smoking (or never start).

A new study has found that patients who smoke significantly increased their risk of reoperation for infection within 90 days of total joint arthroplasty compared with non-smokers and former smokers who had an increased risk of reoperation for any reason.

“Current smoking increases the risk of reoperation due to infection within 90 days of surgery in total joint patients,” Antonia F. Chen, M.D., said in a presentation at the Pennsylvania Orthopaedic Society Fall Scientific Meeting in Philadelphia last week. “Patient indication is key. What some surgeons have instituted is not just taking a patient’s word for quitting smoking, but testing them—doing a urine test of nicotine [and] cotinine—and actually finding that they quit. Then once they quit, [the surgeon] will take them to surgery.”

Chen and her colleagues stratified 15,000 patients who underwent total joint arthroplasty according to smoking status: current, former or non-smoker. Reasons for readmission were categorized as septic, non-septic and nonoperative.

When comparing current smokers with non-smokers, Chen noted septic reoperation was two times more likely for current smokers. However, there was no significant difference in the rate of aseptic reoperation or the rate of nonoperative readmissions between the groups. Chen said no patients experienced nonunion; however, the results showed implant loosening.

“There was no significant difference between current and former smokers with regards to reoperations or readmissions,” said Chen, an orthopaedic surgeon in adult reconstruction who specializes in hip and knee replacement surgery. “So even if a patient quit smoking, the question is, ‘Does that make a big difference or not?’ ”