Nicotine consumption may lead to aseptic loosening in proximal mega-prosthetic femoral replacement

Abstract

BackgroundAseptic loosening after total hip arthroplasty is likely related to nicotine ingestion. However, aseptic loosening as a direct consequence of smoking habits has not been described with regard to proximal mega-prosthetic femoral replacement. The aim of the present study was to evaluate the association between nicotine consumption and aseptic loosening rates after proximal mega-prosthetic femoral replacement.Materials and methodsA consecutive series of patients who received mega-prosthetic replacement of the proximal femur at our hospital between 2005 and 2015 were included. Their files were reviewed and evaluated for the influence of smoking on aseptic loosening rates. All living patients were invited to complete a functional follow-up assessment at our clinic.ResultsTwenty-six patients with 27 prostheses were included. Five patients were active smokers, and 21 patients were non-smokers. Aseptic loosening was observed in three patients in the smoking group, whereas none of the non-smokers developed aseptic loosening. Fisher’s exact test showed a relationship between nicotine consumption and aseptic loosening of the prostheses (p = 0.003).ConclusionsSmoking increases the likelihood of aseptic loosening after proximal mega-prosthetic femoral replacement.Level of evidenceLevel 4 according to Oxford Centre of Evidence-Based Medicine 2011.Electronic supplementary materialThe online version of this article (doi:10.1007/s10195-016-0426-7) contains supplementary material, which is available to authorized users.

High femoral offset as a risk factor for aseptic femoral component loosening in cementless primary total hip arthroplasty

“…A possible explanation for the decreased probability for aseptic loosening in higher age might be the presumed lower activity in the early postoperative period in this population. Regarding the nicotine consumption, increased risk for aseptic loosening has been shown in proximal mega-prosthetic femoral replacement [ 17 ]. However, nicotine abuse showed no increased probability for aseptic loosening in our cohort.…”

“…Postoperative offset restoration and early stem subsidence at three months postoperatively were controlled in the AL group. Besides noting the implant details, medical records were screened for postoperative NSAR, age, and nicotine abuse, presenting other assumed risk factors for aseptic loosening [ 15 , 17 – 19 ]. Furthermore, details were noted for THA indication (primary osteoarthritis or other reason), gender, side, height, weight, and bilateral THA on the same day.…”

“…Femoral offset combinations were determined, and patients grouped regarding the event of aseptic femoral component loosening. Furthermore, patients were screened for other supposed risk factors for aseptic loosening (i.e., non-steroidal antirheumatics (NSAR), age, nicotine) [ 15 , 17 – 19 ]. We hypothesize that patients in whom an implant combination with high femoral offset was used show higher revision rates for aseptic loosening than patients with a combination of standard femoral offset.…”

Effect of Tobacco Use on Radiolucent Lines in Modern Cementless Total Knee Arthroplasty Tibial Components

“…While tobacco usage is declining compared to previous years, a recent study reported that approximately 1 in 5 adults in the United States still use tobacco products [ 30 ]. Tobacco usage is a modifiable risk factor in arthroplasty that has been shown to increase risk of aseptic loosening and osteolysis in cemented TKA and increase aseptic loosening in total hip arthroplasty [ 22 , [31] , [32] , [33] ]. Additionally, tobacco usage in patients who undergo total joint arthroplasty results in increased rates of periprosthetic joint infection, readmission, postoperative complications, all-cause revision, and reoperation [ [34] , [35] , [36] ].…”