Effect of Cigarette Smoking on Patient-Reported Outcomes in Hip Arthroscopic Surgery: A Matched-Pair Controlled Study With a Minimum 2-Year Follow-up

Abstract

Background:The rate of hip arthroscopic surgery has recently increased; however, there is limited literature examining patient-reported outcomes (PROs) in cigarette smokers.Purpose/Hypothesis:The purpose of this study was to evaluate whether smoking status for patients undergoing hip arthroscopic surgery affects clinical findings and PRO scores. We hypothesized that patients who smoke and undergo primary hip arthroscopic surgery will have similar clinical examination findings and preoperative and postoperative PRO scores compared with nonsmoking patients.Study Design:Cohort study; Level of evidence, 3.Methods:Data were collected on all patients who underwent primary hip arthroscopic surgery from February 2008 to July 2015. A retrospective analysis of the data was then conducted to identify patients who reported cigarette use at the time of the index procedure. Patients were matched 1:2 (smoking:nonsmoking) based on sex, age within 5 years, labral treatment (repair vs reconstruction vs debridement), workers’ compensation status, and body mass index within 5 kg/m2. All patients were assessed preoperatively and postoperatively using 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12). Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Significance was set at P < .05.Results:A total of 75 hips were included in the smoking group, and 150 hips were included in the control group. Preoperatively, the smoking group had significantly lower PRO scores compared with the control group for the mHHS, NAHS, and HOS-SSS. Both groups demonstrated significant improvement from preoperative levels. A minimum 2-year follow-up was achieved, with a mean of 42.5 months for the smoking group and 47.6 months for the control group (P = .07). At the latest follow-up, the smoking group reported inferior results for all outcome measures compared with controls. The improvement in PRO scores and rates of treatment failure, revision arthroscopic surgery, and complications was not statistically different between the groups.Conclusion:Patients who smoke had lower PRO scores preoperatively and at the latest follow-up compared with nonsmokers. Both groups demonstrated significant improvement in all PRO scores. These results show that while hip arthroscopic surgery may still yield clinical benefit in smokers, these patients may ultimately achieve an inferior functional status. To optimize results, physicians should advise patients to cease smoking before undergoing hip arthroscopic surgery.

Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported Outcomes and Complications in 18,585 Cases

“…However, none of the PROs exhibited a significant difference between smokers and nonsmokers in the amount of improvement relative to the preoperative baseline. 19 This finding is notable since smokers have been shown to have lower preoperative baseline PRO scores, 25,33 which could in part explain the similarity in the extent of improvement despite most studies reporting significantly lower postoperative PRO scores among smokers.…”

“…Of the 7 included studies, Cancienne et al, 5 Beck et al, 2 Kamath et al, 15 and Lall et al 19 described the postoperative PRO scores ( Table 3). The 2 most commonly reported measures were the modified Harris Hip Score (mHHS) and the visual analog scale (VAS) for pain.…”

“…The 2 studies by Cancienne et al 5 and Lall et al 19 compared the postoperative VAS satisfaction score between smokers and nonsmokers (345 hips collectively; smokers, n = 115; nonsmokers, n = 230). Both authors detected no significant difference between groups (Table 3).…”

“…Only single-institution cohorts in smaller populations have been examined to study this question. Variability of the utilized PROs in the current literature, in addition to the lower utilization rates of hip arthroscopy as compared with its knee and shoulder counterparts, 2,5,8,14,19,25,33 has hindered the assimilation of the available data into inferred recommendations. Therefore, the present systematic review aimed to analyze the current literature describing the impact of smoking on (1) the postoperative PROs, (2) the degree of improvement in PROs relative to preoperative baseline scores, (3) the postoperative complications, and (4) the need for revision or conversion to total hip arthroplasty (THA) after hip arthroscopy.…”

Development of Machine Learning Algorithms to Predict Being Lost to Follow-up After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

“…In the hip arthroscopy literature, smoking has been reported to be a known risk factor for inferior outcomes. 28 , 29 As such, the finding that these patients are also lost to follow-up makes it imperative that they are followed more closely and effort is made to engage with them to try to mitigate the potential to experience these inferior outcomes. Although causation cannot again be established, it is possible that the inferior outcomes experienced by this at-risk population is due in part to failure to follow-up whereby appropriate recommendations or adjustments in the postoperative course cannot be made by the treating surgeon.…”