What Is the Impact of Smoking on Revision Total Knee Arthroplasty?

Bedard, Nicholas A.; Dowdle, S. Blake; Wilkinson, Brandon G.; Duchman, Kyle R.; Gao, Yubo; Callaghan, John J.

doi:10.1016/j.arth.2018.03.024

Cited by 51 publications

(37 citation statements)

References 37 publications

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“…Meldrum et al 17 reported a significantly higher rate of component revision with shorter survival time in THA in smokers. Bedard et al 12 demonstrated that smoking significantly increases the risk of infection and reoperation after TKA. In our study current tobacco use was associated with a significantly shorter implant survival time after TKA.…”

Section: Discussionmentioning

confidence: 99%

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Aseptic Loosening after THA and TKA - Do gender, tobacco use and BMI have an impact on implant survival time?

Schiffner

Latz

Thelen

et al. 2019

Journal of Orthopaedics

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Aseptic loosening (AL) has been reported to be one of the most frequent complications in Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA). The aim of this study was to identify the effects of gender, current tobacco use and BMI on the incidence of AL and implant survival time in THA and TKA. Methods: Between July 2012 and December 2016 all patients that were diagnosed with an AL of a primary THA or primary TKA and underwent revision surgery at a single institution were retrospectively reviewed for this study. For each patient gender, current tobacco use, BMI, and implant survival time were obtained from the medical records. Results: 202 patients with 85 THA and 117 TKA were included in this study. There was no impact of the gender on implant survival times (p > 0.05) in THA and TKA. In the TKA group current tobacco use was associated with a significant shorter implant survival time (p < 0.05). For THA and TKA with cemented stem fixation a significant increase of AL was seen in overweight compared to normal weight patients (p < 0.05) and in obese compared to normal weight patients (p < 0.05). Conclusion: The results demonstrate that current tobacco use and elevated BMI are associated with increased rates of AL in TKA. Also, in THA with cemented stem fixation an elevated BMI is associated with an increased incidence of AL.

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Section: Discussionmentioning

confidence: 99%

“…However, the influence of tobacco use on the survival time of TKA and THA remains subject of controversial discussion. 12,13 Aim of this study is to evaluate the influence of gender, current tobacco use and BMI on incidence of AL and on implant survival time in THA and TKA.…”

Section: Introductionmentioning

confidence: 99%

Aseptic Loosening after THA and TKA - Do gender, tobacco use and BMI have an impact on implant survival time?

Schiffner

Latz

Thelen

et al. 2019

Journal of Orthopaedics

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show abstract

“…Previous research has indicated that several demographic factors may be associated with an increased complication risk after revision THA. Bedard et al [4] found that individuals who were current smokers were more likely to experience deep wound infections or reoperation after revision THA. Similar associations between smoking and postoperative complications have also been reported for patients undergoing revision TKA [4].…”

Section: Introductionmentioning

confidence: 99%

“…Bedard et al [4] found that individuals who were current smokers were more likely to experience deep wound infections or reoperation after revision THA. Similar associations between smoking and postoperative complications have also been reported for patients undergoing revision TKA [4]. Further studies have reported that although advanced age and high comorbidity burden are associated with higher rates of mortality or major complications after revision THA, the effect of obesity on risk of complications is less clear [3,16,4].…”

Section: Introductionmentioning

confidence: 99%

Are Patients Who Undergo THA for Infection at Higher Risk for 30-day Complications?

Boniello

Lieber

Courtney

2019

Clin Orthop Relat Res

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Background Value-based payment models, such as bundled payments, continue to become more widely adopted for total joint arthroplasty. However, concerns exist regarding the lack of risk adjustment in these payment and quality reporting models for THA. Providers who care for patients with more complicated problems may be financially incentivized to screen out such patients if reimbursement models fail to account for increased time and resources needed to care for these more complex patients. Questions/purposes (1) Are patients who undergo revision THA for infectious causes at greater adjusted risk of 30-day short-term major complications, return to the operating room, readmission, and mortality compared with patients undergoing aseptic revision? (2) What are other independent factors associated with the risk of 30-day major complications, readmission, and mortality in this patient population? Methods We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for all patients undergoing revision THA from 2012 to 2015. The NSQIP database allows for the analysis of 30-day surgical outcomes, including postoperative complications, return to the operating room, readmission, and mortality of patients from approximately 400 participating institutions. The NSQIP was selected over other larger databases, such as the National Impatient Sample (NIS), because the NSQIP includes readmission data and 30-day complications rates that were relevant to our study. Patients undergoing aseptic revision THA and those undergoing revision THA with a diagnosis of periprosthetic joint infection were identified. We identified 8973 patients who underwent revision THA and excluded six patients due to a diagnosis of malignancy leaving 8967 patients; 726 (8%) of these were due to infection. Demographic variables, medical comorbidities, and 30-day major complications, hospital readmissions, reoperations, and mortality were compared among patients undergoing aseptic and infected revision THA. A major complication was defined as myocardial infarction, postoperative mortality, sepsis, septic shock, and stroke. A multivariate logistic regression analysis was then performed to identify factors independently associated with the primary Each author certifies that neither he, nor any member of his immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his institution waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

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“…Cigarette smoking is associated with increased postoperative pulmonary complications, surgical site infections, venous thrombosis, and cardiovascular complications. Smoking alters peripheral vasculature and increases carboxyhemoglobin levels, which can impair incision healing . Active smokers are more likely to experience postoperative total joint replacement infection, necessitating reoperation .…”

Section: Prehabilitationmentioning

confidence: 99%

Prehabilitation and Optimization of Modifiable Patient Risk Factors: The Importance of Effective Preoperative Evaluation to Improve Surgical Outcomes

Boudreaux¹,

Simmons²

2019

AORN Journal

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What Is the Impact of Smoking on Revision Total Knee Arthroplasty?

Cited by 51 publications

References 37 publications

Aseptic Loosening after THA and TKA - Do gender, tobacco use and BMI have an impact on implant survival time?

Aseptic Loosening after THA and TKA - Do gender, tobacco use and BMI have an impact on implant survival time?

Are Patients Who Undergo THA for Infection at Higher Risk for 30-day Complications?

Prehabilitation and Optimization of Modifiable Patient Risk Factors: The Importance of Effective Preoperative Evaluation to Improve Surgical Outcomes

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