Smoking May Be a Harbinger of Early Failure With Ultraporous Metal Acetabular Reconstruction

Abstract

Background Smoking is considered a risk factor for surgical complications in total hip arthroplasty (THA) and has been linked to a higher rate of aseptic loosening in uncemented acetabular components. Acetabular reconstruction with newer ultraporous metals in both complex primary and revision THA has increased survivorship but it is unclear whether smoking affects survival of these implants.Questions/purposes We reviewed our early experience with THA using ultraporous acetabular components to assess the incidence and etiology of early failure and examine if any preoperative variables, including smoking, related to failure. Methods We used ultraporous acetabular components in 498 patients (534 hips), beginning with one case each in 1999 and 2004, 17 in 2005, and the majority from 2006 through March 2010. There were 159 complex primary and 375 revision cases. Of these patients, 17% were smokers (averaging 35 pack-years), 31% previous smokers (averaging 29 pack-years), 41% nonsmokers, and 1% unknown. Failure modes possibly related to smoking were infection, aseptic loosening, or periacetabular fracture and unrelated were dislocation and implant breakage. Minimum followup was 1 month (average, 32 months; range, 1-78 months). Results There were 34 cup failures (6%): 17 infections, 14 aseptic loosening, and one each liner breakage, dislocation, and periacetabular fracture. The failure rate (uncontrolled for potentially confounding variables) was 10% in both current (9 of 89) and prior smokers (17 of 167) and 3% in nonsmokers 8 of 271). Conclusion With ultraporous metal technology in complex primary and revision THA, smoking, both past and current, may be a risk factor for early failure.

Strong association between smoking and the risk of revision in a cohort study of patients with metal‐on‐metal total hip arthroplasty

“…However, we reported separate incidence rates for current and former smokers. The fact that the results did not substantially differ between current and former smokers in the MoM group is in accordance with the study by Lombardi et al and with the finding that the association between smoking and increased risk of nickel sensitization was present in both former and current smokers …”

“…The review reported an unadjusted relative risk for reoperation or revision of 1.4 (95% CI 0.6–2.1) comparing current smokers with never‐smokers and of 1.2 (95% CI 0.8; 1.6) comparing former smokers with never‐smokers, similar to our results in the CoP group. Moreover, another study evaluating one specific cup design found an increased risk of early failure among current (10%) and former smokers (10%) compared with never‐smokers (3%) . There have been no studies examining the influence of smoking on hip arthroplasty failure depending on the type of bearing surface.…”

Smoking and Risk of Prosthesis-Related Complications after Total Hip Arthroplasty: A Meta-Analysis of Cohort Studies

“…Moreover, Khan et al [ 11 ] defined former smokers as the patients who quit smoking over 30 days before admission to hospital, whereas former smokers in the study by Kapadia et al [ 9 ] were labeled as the patients who quit smoking over 30 days before the date of the operation. Lombardi et al [ 10 ] did not provide a definition for former smokers in their study. These characteristics may result in an under- or over-estimation of the risk.…”

The Effect of Smoking on Short-Term Complications Following Total Hip and Knee Arthroplasty

“…Smoking is a modifiable patient factor that has been previously shown to increase postoperative complications [8][9][10][11][12]33,[38][39][40] . Several studies have suggested that smoking-cessation programs provide a cost-effective method of reducing complications [20][21][22] .…”