Smoking, Drinking Increase Risks of Poor Outcomes After Revision Total Hip and Knee Joint Arthroplasty

Subscribe to the latest updates from Orthopaedics Advances in Motion

Thank you for subscribing!

Error: Please enter a valid email address.

Email Address Submit

As the population ages, the burden of total joint arthroplasty (TJA) is expected to increase in terms of complication rates, costs and poor outcomes. Smoking and drinking, either separately or together, are established risk factors for poor outcomes after primary TJA.

The same is true after revision TJA, according to a study by Georges Bounajem, MD, former arthroplasty fellow, Ameen Barghi, Harvard Medical School student and Young-Min Kwon, MD, PhD, program director of the Adult Reconstructive Surgery Fellowship Program and director of the Bioengineering Laboratory in the Department of Orthopaedic Surgery at Massachusetts General Hospital, and colleagues. They published their findings in the Journal of the American Academy of Orthopaedic Surgeons.

Study Methods

The researchers retrospectively evaluated 3,336 consecutive patients who underwent revision of total knee or total hip arthroplasty. They divided them into:

• Nonusers (neither smoking nor drinking)
• Smokers only (≥1 cigarette/day)
• Drinkers only (≥1 alcoholic drink/day for women; ≥2 drinks/day for men)
• Concurrent users (smoking and drinking)

The researchers used propensity scores to match the groups on age, sex, body mass index, ASA score and indication for revision. This left 1,924 patients: 808 nonusers, 421 smokers, 483 drinkers and 212 concurrent users.

Nonusers vs. Users

Compared with nonusers, substance users as a whole had a significantly higher risk of:

• Two or more in-hospital complications (OR, 1.63)
• Increased hospital stay (OR, 1.56)
• Readmission within 60 days (OR, 1.35)
• Major complications within 90 days postdischarge (overall OR, 1.72), including greater odds of revision surgery (OR, 1.84) and wound dehiscence (OR, 2.79)
• Aseptic failure (OR, 1.37; P=.03) and septic failure (OR, 1.84)

Nonusers vs. Concurrent Users

Compared with nonusers, concurrent users had a significantly higher risk of:

• Two or more in-hospital complications (OR, 4.13)
• Hospital stay >11 days (OR, 2.02)
• Discharge to inpatient rehabilitation (OR, 2.31)
• Readmission within 60 days (OR, 1.60) or 90 days (OR, 1.57)
• Major complications within 90 days (OR, 2.74), including revision surgery (OR, 2.26)
• Re-revision surgery for prosthetic joint infection (OR, 2.44)

Concurrent Users vs. Users

Smokers and drinkers had similarly poor outcomes after discharge, but concurrent users had worse outcomes compared with either single user group. Compared with smokers, they had a significantly higher risk of:

• Two or more in-hospital complications (OR, 2.14)
• Major complications within 90 days (OR, 1.62)

Compared with drinkers, concurrent users had a significantly higher risk of:

• Two or more in-hospital complications (OR, 4.13)
• Discharge to inpatient rehabilitation (OR, 3.09)
• Major complications within 90 days (OR, 1.64)

It remains important for clinicians to intervene early and help patients change these modifiable risk factors associated with poor outcomes following revision total hip and knee joint arthroplasty.

view original journal article Subscription may be required

Learn more about the Department of Orthopaedic Surgery

Refer a patient to the Department of Orthopaedic Surgery