Systematic Review and Meta-Analysis of Tobacco Use as a Risk Factor for Prosthetic Joint Infection After Total Hip Replacement

Abstract

Background A prosthetic joint infection (PJI) is one of the possible complications after total hip arthroplasty (THA). Several studies, but not all, have reported smoking as a risk factor of PJIs in orthopaedic surgery. This study summarizes the most recent evidence using a systematic review of whether tobacco use (not only tobacco smoking) is a risk factor in developing PJIs, specifically after THA. Methods Ovid Medline, EMBASE, Scopus, Web of Science, and Cochrane databases were searched from inception to July 2019 to identify case-control studies that examined the PJI risk in tobacco users and tobacco nonusers undergoing THA. Publication bias was also assessed through funnel plots. Results Searches identified 2689 articles, and 10 of these, involving a total of 20,640 patients, met the inclusion criteria. The overall odds ratio (pooled odds ratio) to develop either a superficial infection, a deep infection, or an infection requiring revision surgery for tobacco users vs nonusers was 1.54 (95% confidence interval: 1.25-1.91) when a fixed-effect model was used and 1.56 (95% confidence interval: 1.10-2.21) when a random-effect model was used. No publication bias was observed among the identified studies. Conclusions The findings of the study indicated that tobacco use is associated with a higher risk of PJIs in patients undergoing THA.

Prevention of early complications following total hip replacement

“…In one of the largest prospective studies encompassing 8559 total joint replacements, smoking resulted in a 1.8 fold risk of prosthetic joint infection [51]. In concordance, a recent systematic review and meta-analysis including 10 studies and 20,640 patients corroborated the association of PJI with tobacco use [52]. Hence it is recommended that smoking should stop at least four weeks before surgery [42], and THA should be performed at least three months after an intra-articular injection [53].…”

Insurance Status Predicts Periprosthetic Joint Infection after Total Hip Arthroplasty

“…36 The workers compensation group in this study had a significantly higher proportion of men, smokers, and obesity when compared with the Medicare group, all of which have been shown to be independent risk factors for PJI following THA, especially male gender and obesity. 18,27,37 After adjusting for these demographic variables, interestingly workers compensation coverage was not found to be an independent risk factor for PJI. Further research is needed on this group to understand the relation between worker's compensation and PJI and all potential complications following THA.…”

Effect of tobacco usage on surgical site wound problems after primary total hip and total knee arthroplasty: A meta‐analysis

“…Despite our efforts with the re‐defined analysis and using end points of both SSWP and any SSWP to produce a more accurate pooling of data, there was still heterogeneity in the definitions for infectious end points and tobacco use status for each included study. The outcome of the meta‐analyses was probably impacted by this 23–26 …”

“…The outcome of the meta-analyses was probably impacted by this. [23][24][25][26] The limitations of this meta-analysis are given next. There could be an assortment bias because some of the studies that were chosen for the meta-analysis were excluded.…”