Smoking and Outcomes after Knee and Hip Arthroplasty: A Systematic Review
Jasvinder A. SinghHip Knee
Background
Studies have suggested higher rates of peri- and post-operative complications in smokers compared to non-smokers. The objective of this systematic review was to assess the association of smoking and post-operative outcomes following total hip arthroplasty (THA) or total knee arthroplasty (TKA).
Methods
A search of six databases (The Cochrane Library, Scopus, Proquest Dissertation abstracts, CINAHL, OVID MEDLINE and EMBASE) was performed by a Cochrane librarian. All titles and abstracts were screened by two independent reviewers, with expertise in performing systematic reviews. Studies were included if they were fully published reports that included smoking and any perior post-operative clinical outcome in patients with either TKA or THA.
Results
21 studies were included for the review, of which six included multivariable-adjusted analyses, 14 univariate analyses and one statistical modeling. For most outcomes, results from 1-2 studies could be pooled. Current smokers were significantly more likely to have any post-operative complication (risk ratio, 1.24 [95% confidence interval, 1.01 to 1.54]) and death (risk ratio, 1.63 [95% confidence interval, 1.06 to 2.51]), compared to non-smokers. Former smokers were significantly more likely to have any post-operative complication (risk ratio, 1.32 [95% confidence interval, 1.05 to 1.66]) and death (risk ratio, 1.69 [95% confidence interval, 1.08 to 2.64]).
Conclusion
This systematic review finds that smoking is associated with significantly higher risk of post-operative complication and mortality following THA or TKA. Studies examining long-term consequences of smoking on implant survival and complications are needed. Smoking cessation may improve outcomes after THA or TKA.
Link to article