Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population‐based cohort of men

Abstract

Objective. To assess the associations of smoking, body weight, and physical activity with risk of undergoing total joint replacement (TJR) in a population-based cohort of men.Methods. A cohort study of 11,388 men that integrated clinical data with hospital morbidity data and mortality records was undertaken. The risk of undergoing TJR was modeled on baseline weight, height, comorbidity, socioeconomic status, years of smoking, and exercise in 3 separate age groups, using Cox proportional hazards regressions and competing risk regressions (CRRs).Results. Dose-response relationships between weight and risk of TJR and between smoking and risk of TJR were observed. Being overweight independently increased the risk of TJR, while smoking lowered the risk. The decreased risk among smokers was demonstrated in both Cox and CRR models and became apparent after 23 years of exposure. Men who were in the highest quartile (>48 years of smoking) were 42-51% less likely to undergo TJR than men who had never smoked. Tests for trend in the log hazard ratios (HRs) across both smoking and weight quantiles yielded significant P values. Vigorous exercise increased the hazard of TJR; however, the association reached statistical significance only in the 70-74-year-old age group (adjusted HR 1.64 [95% confidence interval 1.19-2.24]). Adjusting for Deyo-Charlson Index or Elixhauser's comorbidity measures did not eliminate these associations.Conclusion. Our findings indicate that being overweight and reporting vigorous physical activity increase the risk of TJR. This study is the first to demonstrate a strong inverse dose-response relationship between duration of smoking and risk of TJR. More research is needed to better understand the role of smoking in the pathogenesis of osteoarthritis.

Relationship between cigarette smoking and radiographic knee osteoarthritis in Chinese population: a cross-sectional study

“…This study suggested that the primary exposure of cigarette smoking was negatively associated with radiographic knee OA in the Chinese population, which was consistent with some previous researches [29,[40][41][42][43]. Two recent studies, including a large-sample prospective cohort study conducted by Mnatzaganian et al [40,41], considered total joint replacement (TJR) as a surrogate indicator of severe OA and demonstrated a strong inverse dose-response relationship between the duration of cigarette smoking and the risk of TJR. Another important largesample prospective cohort study conducted by Leung [29] reported a very strong dose-dependent association between the increased duration and dosage of cigarette smoking and the decreased risk of total knee replacement (TKR) among active smokers.…”

Propensity score matching and randomization

“…Of the initially recruited 12,203 participants, 2,202 were eligible to participate in this study and were followed from baseline screening (1996e1999) until they experienced their first elective primary total hip or total knee replacement (TKR) or died or were right censored at the end of follow-up (March 2007) [9,10].…”

Smoking and osteoarthritis

“…However, the majority of TJRs in this study were undertaken in the private hospital setting (78.5%). Those treated in the public system were more likely to be socioeconomically disadvantaged and smoked more years 5 , and therefore more likely to have waited longer for the surgery.…”

“…4,5 Headlines such as this, however, can disrupt tobacco control messages that are provided by public health organisations and government health departments to reduce the prevalence of smoking in the community.…”