Smokers at Greater Risk For Post-Knee Replacement Revision
Smoking is the biggest factor in determining how likely a patient is to undergo total knee arthroplasty (TKA) revision, according to a recent study.
In an analysis of 436 patients, participants were identified using the Partners Research Patient Data Registry, and were eligible for inclusion if they had received a TKA sometime between January 1996 and January 2009. Among these participants, 146 had undergone both a primary and revision TKA (the case group), and 290 patients with received a primary TKA without an identified revision (the control group). The mean age of patients in the case group was 57.8 years, and the mean age in the control group was 65.4 years.
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A team including researchers from the Hospital for Special Surgery and Brigham and Women’s Hospital performed an additional exploratory analysis as well, examining risk factors for revision due to infection along with factors for aseptic revision in separate models.
In these models, the authors found that lateral release was linked to a more-than-fivefold greater risk of revision for infection, but the data did not produce sufficient evidence to establish a clinically significant relationship between lateral release and aseptic revision.
Smoking was found to increase the risk of aseptic revision by more than fourfold, although the investigators did not establish a meaningful clinical relationship between smoking and greater risk for infectious revision.
“We are aware, of course, that smoking is associated with many negative health outcomes. Here is another one,” says Jeffrey Katz, MD, MSc, a professor of medicine and orthopedic surgery at Harvard Medical School and Brigham and Women’s Hospital, and co-author of the study.
For patients with a total knee replacement in place, the risk factor associated with smoking is “very personal,” says Katz. “Knowing that smoking may reduce the survival of their implant may be a powerful incentive to some patients to stop smoking, whereas less personally relevant risks might not have moved to change [their] behavior.”
—Mark McGraw
Reference
Nwachukwu B, Gurary E, et al. Effects of smoking and soft tissue release on risk of revision after total knee arthroplasty: a case control study. BMC Musculoskelet Disord. 2015.