Study | No. Patients, THA or TKA | Type of Study/Quality Score* | Population | Smoking | Covariates | Findings |
---|---|---|---|---|---|---|
Multivariable-adjusted analyses | ||||||
Sadr Azodi45 | 3309 pts, THA | Observational, cohort study Score 7 | Swedish Arthroplasty Register | Former, current, and nonsmoker; pack-yrs smoking | Age, calendar period, region, diabetes, heart failure, lung disease, stroke, BMI, tobacco-related | Multivariable: compared to nonsmokers, significantly higher risk of systemic complications in: former smokers (OR 1.32, 95% CI 1.04 to 1.97); current smokers (OR 1.56, 95% CI 1.14 to 2.14) > 40 pack-yrs (OR 2.21, 95% CI 1.28 to 3.82) |
Lavernia46 | 203 pts: 203 THA or TKA (primary or revision) | Observational cohort Score 9 | Single center | Former current, and non-smoker; pack-yrs smoking | Age, sex, BMI, diagnosis, surgeon, procedure, comorbidities | Multivariable: smoking was significant predictor for charges (p = 0.03), operative time (p = 0.01), and anesthesia time (p = 0.003) |
Fisher47 | 71 pts: 71 TKA (148 controls) | Observational case-control study Score 4 | Single center | Smoking: yes/no | Sex, arthrotomy, disabled, diabetes, chronic lung disease, retired | Multivariable: Smoking associated with lower risk of painful/stiff knee (OR 0.26, p = 0.049) |
Moller48 | 811 pts: 811 THA or TKA | Observational cohort study Score 9 | Single center | Smoking: Current smoker vs nonsmoker (included prior smokers) | Age, sex, BMI, ASA class, comorbidity, surgery type, anesthesia duration, surgery duration, alcohol use | Multivariable: smoking significantly associated with higher risk of any complication (OR 3.2, 95% CI 1.8 to 6.0); wound complication (OR 8.5, 95% CI 1.6 to 47); and ICU admission (OR 2.4, 95% CI 1.4 to 3.8) |
Espehaug49 | 674 primary THA; 1343 controls | Observational, matched case-control Score 8 | Norwegian Arthroplasty Register | Smoking: never, former, current | Antibiotic, cement, prosthesis brand; matched for age, operation date, bilaterality | Multivariable: neither former nor current smoking associated with increased revision; former heavy smokers (≥ 12 pack-yrs) significantly increased risk of revision (OR 2.6, 95% CI 1.5 to 4.4) |
Sadr Azodi50 | 2106 THA pts | Observational cohort study Score 7 | Swedish Inpatient Register | Former, current, and nonsmoker; pack-yrs smoking | Age, calendar period, BMI, fixation | Multivariable: no significant association of smoking status or pack-yrs of smoking and risk of implant dislocation up to 3 yrs after primary THA |
Meldrum51 | 147 pts: 165 THA | Observational cohort study Score 8 | Single center | Smoking: yes/no | Age, sex, BMI, diagnosis, stem fixation, alcohol use | Multivariable: smokers with nonsignificantly higher hazard rate of revision than nonsmokers, 4.5 (p = 0.066) |
Univariate Analyses | ||||||
Bischoff-Ferrari52 | 922 pts: 922 primary THA | Observational cohort study Score 8 | Stratified random Medicare sample | Current smoking yes/no | Univariate | Univariate: poor functional status in smokers vs nonsmokers (OR 0.8, 95% CI 0.3 to 2.0) |
Anderson53 | 101 pts: 101 THA | Observational cohort study Score 6 | Multicenter | Smoking yes/no | Univariate | Univariate: smoking not associated with risk of venous thromboembolism |
Beksac54 | 1947 pts: 2032 THA | Observational cohort study Score 4 | Hospital for Special Surgery (NY) database | Smoking yes/no | Univariate | Univariate: no significant association of smoking and venous thromboembolism up to 3 mo post-THA |
Sharrock55 | 448 pts: 448 TKA | Observational cohort study Score 5 | Single center | Smoking yes/no | Univariate | Univariate: smoking not associated with risk of deep vein thrombosis |
Horne56 | 392 pts: 392 TKA | Observational case-control Score 4 | Single center | Smoking yes/no | Univariate | Univariate: smoking not associated with risk of infection following TKA (OR 1.6, 95% CI 0.3 to 6.3; p = 0.46) |
Malinzak57 | 17,561 pts: 17,561 THA or TKA | Observational cohort study Score 5 | Single center | Smoking yes/no | Univariate | Univariate: smoking not associated with risk of infection |
Cates58 | 37 pts: 37 TKA | Observational cohort study Score 6 | Single center | Smoking yes/no | Univariate | Univariate: smoking not associated with flexion or extension gain at 1 year post-manipulation |
Grosflam59 | 295 pts: 295 THA | Observational cohort study Score 7 | Single center | Smoking yes/no | Univariate | Univariate: smoking not associated with total blood loss intraoperatively |
Inoue60 | 130 pts: 151 THA | Observational cohort study Score 5 | Single center | Smoking yes/no | Univariate | Univariate: smoking not associated with early implant loosening (OR 0.30, 95% CI 0.06 to 1.52; p = 0.15) |
Nixon61 | 127 pts: 127 THA | Observational case-control study Score 5 | Single center, UK hospital-based cohort | Active smokers: yes/no | Univariate | Univariate: among those with loosening of implant, more active smokers (8/59) than among those with stable implants (1/26) (OR 5.5, 95% CI 0.8 to 38; p = 0.08) |
Khan62 | 1767 pts: 1767 THA | Observational cohort study Score 7 | Single center | Smoking yes/no | Univariate | Univariate: smoking not associated with the risk of superficial infection (OR 1.0, 0.5 to 1.8), deep infection (OR 3.4 0.7 to 17.2), or revision (OR 0.8, 0.1, 2.6) |
Malik63 | 224 pts: 224 THA | Case-control study Score 7 | Single center | Former, current, and nonsmokers | Univariate | Univariate: smoking not associated with implant loosening at 6-yr followup |
Peersman64 | 6120 pts: 6489 TKA; 113 infected TKA in 113 pts | Observational, case-control study Score 4 | Single center | Smoking yes/no | Univariate | Univariate: smoking associated with risk of infection following TKA (p = 0.01) |
↵* Quality scores calculated using the Ottawa-Newcastle system designed for observational studies with separate scales for case-control and cohort studies; studies can be awarded 4 points for selection of case/controls, 2 points for comparability of cases and controls, 3 points for exposure assessment. Score range = 0–9, 9 = best quality score. NA: not applicable; THA: total hip arthroplasty; TKA: total knee arthroplasty; OA: osteoarthritis; Prim: primary; Rev: revision; BMI: body mass index; ASA: America Society of Anesthesiologists.