New study finds smokers have a higher risk of revision knee replacement surgery

A new study released recently in the US looked at the link between smoking and the increased risk of revision following total knee replacement. A group of 436 patients were studied, examining the reasons for a revision procedure being required.

The predominant reason for the initial procedure was osteoarthritis and it was found that the most common indication for a revision procedure was infection at 30 per cent, ‘aseptic loosening’ at 18 per cent, stiffness at 18 per cent and instability at 13 per cent.

Smoking was associated with more than a fourfold increase to the risk of aseptic loosening as nicotine has been shown to disrupt the process of osteointegration which is where the implant and bone bonds for long-term stability.

Smoking and surgery

Mr Jonathan Webb discusses smoking and the importance of stopping in advance of your knee surgery with all patients. As well as increasing the risk of requiring a revision procedure, smokers can experience a number of problems, both during and after the surgery:

• the Royal College of Anaesthetists advise smokers to quite for at least a few weeks before surgery to reduce the risk of breathing problems
• higher chance of lung or heart complications
• remain in hospital longer and a more increased risk of being admitted to intensive care or dying in hospital than non-smokers
• nicotine constricts the blood vessels so the wounds get less oxygen so healing is prolonged
• the wound receives fewer white blood cells, greatly increasing the risk of infection

Smoking and revision knee replacement surgery

The problems of smoking and total knee replacement are well documented, but smoking impacts the outcome of all types of knee surgery. The good news is that making the decision to quit can speedily make a positive impact on your health. One study published last year in the Journal of Bone & Joint Surgery that looked at the link between smoking and anterior cruciate ligament (ACL) reconstruction found that patients that stopped smoking at least one month prior to their procedure had no significant difference in their outcomes compared with a lifetime non-smoker.