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

By William P Barrett, MD

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. This study was published in The Journal of Bone and Joint Surgery February 15, 2017. In this study, they looked at patients who underwent a primary hip or knee replacement between 2000 and 2014. Patients were stratified into 1 of 3 groups:  Current smokers, former smokers, and nonsmokers. They looked at patients who underwent 8917 hip replacements and 8477 knee replacements. 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 had an almost double risk of reoperation for infectious complications when compared to nonsmokers. After adjusting for other characteristics, current smokers had a relative risk of reoperation that was 80% higher than nonsmokers. The study also showed that regardless of current smoking status, the amount that one smoked over time significantly contributed to the increased risk of complication.

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.