Impact of Smoking on the Incidence and Postoperative Complications of Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Cohort Studies

Abstract

Osteoarthritis and rheumatoid arthritis are the most ubiquitous joint disorders which cause tremendous loss of life quality and impose an economic burden on society. At present, the treatment options for these two diseases comprise non-operative and surgical treatments, amongst those total knee arthroplasties (TKA). Various studies have recognized smoking as a significant risk factor for postoperative complications. Therefore, the purpose of this study was to examine the impact of smoking on the incidence and postoperative complications after a total knee arthroplasty by a systematic review and meta-analysis. The research was performed using PUBMED, Cochrane Library and EMBASE, extracting data from thirteen suitable studies and incorporating 2,109,482 patients. Cohort studies evaluating the impact of smoking on TKA with sufficient data were included for the study, and cohort studies without a proper control group and complete data were excluded. A fixed-effects or random-effects model was used to measure the pooled risk ratio (RR) or hazard ratio (HR) with 95% confidence interval (CI). Compared to non-smokers, smokers had a significantly lower incidence of TKA (p<0.01). However, smokers had a higher incidence of total complications (p=0.01), surgical complications (p<0.01), pneumonia (p<0.01) and revision surgery (p=0.01). No significant difference in the risk of blood transfusion (p=0.42), deep vein thrombosis (p=0.31), pulmonary embolism (p=0.34), urinary tract infection (p=0.46) or mortality (p=0.39) was found between smokers and non-smokers. In conclusion, the study indicated that tobacco has two diametrically opposite effects on TKA patients: 1. Tobacco increases the incidence of surgical complications, pneumonia and revision after TKA; 2. It decreases the overall risk of being a candidate for TKA.

Osteoarthritis Risks and Sports: An Evidence-based Systematic Review

“…The number of both meniscal injuries and knee sprains were highest in mixed sports. (13) We found that former aerobic sports athletes in particular have high total and active life expectancy and low risk for ischemic heart disease and diabetes in later years.…”

“…[7][8][9][10] Over the past several years, it was possible to identify factors associated with an increased risk of lower extremity OA such as aging, obesity, smoking, lower limb malalignment, trauma, as well as haematological and rheumatological diseases. [11][12][13][14] Regular sports activities may decrease the risk of diseases such as osteoporosis, diabetes mellitus, hypertension, and cardiovascular disease, and reduce premature mortality. [15][16][17][18][19][20] Sports participation does not only bring welldocumented health benefits, but it is also associated with psychological benefits, including higher quality of life and better coping strategies.…”

“…Mostly affecting elderly patients, OA is in particular burdensome for younger adults, as they have high demands regarding their work capacity and level of physical and sports activity 7–10. Over the past several years, it was possible to identify factors associated with an increased risk of lower extremity OA such as aging, obesity, smoking, lower limb malalignment, trauma, as well as haematological and rheumatological diseases 11–14…”

How and why tobacco use affects reconstructive surgical practice: a contemporary narrative review

“…The authors however contended BMI as a confounder in all the studies included and postulated that it may have a larger effect than smoking (34). Nevertheless, there remains no evidence that smokers have higher incidence of postoperative DVTs compared to non-smokers (35)(36)(37).…”

At the Edge of Orthopaedics: Initial Experience with Transarterial Periarticular Embolization for Knee Osteoarthritis in a Romanian Population

“…Furthermore, a recent nationwide cohort study proved the increase risk of OA advancement in patients with dementia [ 8 ]. Smokers are a population group that have been recently categorized at increased risk of surgical complications after TKR; they have a higher postoperative incidence of overall surgical complications, pneumonia, and revision surgery [ 9 ]. Due to increased risks of complications, an alternative, less invasive procedure for patients in these population groups is continuously sought [ 10 ].…”