This account is pending registration confirmation. Please click on the link within the confirmation email previously sent you to complete registration.
Need a new registration confirmation email? Click here
Stocks Under $10 with 50-100% upside potential - 14 days FREE!

Smoking Associated With Hip And Knee Replacement Failure

Orthopaedic surgeons outline steps to help patients stop smoking, ideally before surgery

ROSEMONT, Ill., April 12, 2012 /PRNewswire-USNewswire/ -- Tobacco and nicotine use are known to impair the body's ability to heal bones and wounds. Two new studies presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons looked at the effects of smoking on total joint replacement.  A separate Smoking Cessation Forum featured expert testimony on how orthopaedic surgeons may successfully encourage and aid patients in quitting smoking, optimally before surgery.

The first study, "Increased Revision Rates Following Total Knee Arthroplasty in Patients Who Smoke," found that patients who smoke before and/or after total knee replacement (TKR) surgery had a 10-fold higher revision rate compared to non-smokers. The investigation involved 621 TKR patients, including 131 smokers (median age 62).  All patients who were smokers were encouraged to participate in a smoking cessation program prior to TKR surgery.  Clinical outcomes, including pain, function and range of motion, were assessed following surgery in both groups. The smoking group had 13 knee replacement failures (10 percent) compared to five in the non-smoking group (1 percent).  The medical complication rate also was "significantly higher" in the smoking group, with 27 patients (21 percent) having a medical complication compared to 60 (12 percent) of non-smokers. Complications included deep venous thrombosis (DVT) or blood clots, anemia requiring treatment, cardiac problems, and acute renal failure. Investigators recommend that patients stop or minimize nicotine use prior to TKR.

The second study, "Smoking is a Harbinger of Early Failure with Ultraporous Metal Acetabular Reconstruction," looked at the effects of smoking on patients who underwent reconstruction of the acetabulum – the cup shaped cavity at the base of the hip bone – with ultraporous metal. In general, the newer materials have resulted in increased survival rates and fewer hip replacement failures than other implants made from standard porous metal. Between 1999 and 2009, ultraporous acetabular components were used in 533 hip replacements, including 159 primary and 374 revision surgeries. Of these patients, 17 percent were smokers, 31 percent previous smokers, 50 percent non-smokers, and 3 percent unknown. The failure rate in smokers was 9.1 percent, compared to 3.4 percent in non-smokers.  Investigators recommend that orthopaedic surgeons strongly advocate for smoking cessation before surgery to ensure optimal recovery and outcome.

During the Smoking Cessation Forum, experts provided testimony on the harmful ingredients and outcomes associated with smoking. Patients who quit smoking before and during orthopaedic treatment have less pain than those who smoke, but also better outcomes.

Among the recommendations provided by orthopaedic surgeons during the Forum:  

  • Orthopaedic surgeons can help ensure optimal care by refusing to perform surgery on patients who smoke, said Glenn R. Rechtine, MD, an orthopaedic surgeon and associate chief of staff and adjunct professor at the University of South Florida.  Forty percent of Dr. Rechtine's patients have stopped smoking as a result of his mandate.
  • Richard D. Hurt, MD, professor of medicine and director of the Nicotine Dependence Center at Mayo Clinic, outlined a three-step process that clinicians can initiate to help their patients stop smoking.  "First, ask about tobacco use," said Dr. Hurt. "Have your receptionist ask, your nurse ask, your physician's assistant ask, and you ask – even if you already know the answer. Asking shows the patient that smoking is a serious problem that must be addressed. Then, advise the patient to stop smoking. Don't just say, 'you know, you ought to consider stopping someday.' Tell the patient, 'you need to stop smoking.' Finally, because smokers are going to push back, it's important to offer help."  Each state has a free Quitline (1-800-QUIT-NOW) that provides free, telephone counseling, by trained professionals, said Dr. Hurt.
  • David O. Warner, MD, associate dean for clinical and translational science at Mayo Clinic, urged the Academy to replicate the American Society of Anesthesiologists' (ASA) Smoking Cessation Initiative which strives to offer smoking cessation assistance to every patient who smokes.  "Smoking is the most costly and most preventable risk factor in postoperative complications," said Dr. Warner. "Surgery is a teachable moment – one we need to capitalize on."

About AAOS

Follow us on  Facebook.com/AAOS1 and  Twitter.com/AAOS1

For more information on bone and joint health, visit OrthoInfo.org

SOURCE American Academy of Orthopaedic Surgeons

Copyright 2011 PR Newswire. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Select the service that is right for you!

COMPARE ALL SERVICES
Action Alerts PLUS
Try it NOW

Jim Cramer and Stephanie Link actively manage a real portfolio and reveal their money management tactics while giving advanced notice before every trade.

Product Features:
  • $2.5+ million portfolio
  • Large-cap and dividend focus
  • Intraday trade alerts from Cramer
  • Weekly roundups
TheStreet Quant Ratings
Try it NOW
Only $49.95/yr

Access the tool that DOMINATES the Russell 2000 and the S&P 500.

Product Features:
  • Buy, hold, or sell recommendations for over 4,300 stocks
  • Unlimited research reports on your favorite stocks
  • A custom stock screener
  • Upgrade/downgrade alerts
Stocks Under $10
Try it NOW

David Peltier, uncovers low dollar stocks with extraordinary upside potential that are flying under Wall Street's radar.

Product Features:
  • Model portfolio
  • Stocks trading below $10
  • Intraday trade alerts
  • Weekly roundups
Dividend Stock Advisor
Try it NOW

Jim Cramer's protege, David Peltier, identifies the best of breed dividend stocks that will pay a reliable AND significant income stream.

Product Features:
  • Diversified model portfolio of dividend stocks
  • Alerts when market news affect the portfolio
  • Bi-weekly updates with exact steps to take - BUY, HOLD, SELL
Real Money Pro
Try it NOW

All of Real Money, plus 15 more of Wall Street's sharpest minds delivering actionable trading ideas, a comprehensive look at the market, and fundamental and technical analysis.

Product Features:
  • Real Money + Doug Kass Plus 15 more Wall Street Pros
  • Intraday commentary & news
  • Ultra-actionable trading ideas
Options Profits
Try it NOW

Our options trading pros provide daily market commentary and over 100 monthly option trading ideas and strategies to help you become a well-seasoned trader.

Product Features:
  • 100+ monthly options trading ideas
  • Actionable options commentary & news
  • Real-time trading community
  • Options TV
To begin commenting right away, you can log in below using your Disqus, Facebook, Twitter, OpenID or Yahoo login credentials. Alternatively, you can post a comment as a "guest" just by entering an email address. Your use of the commenting tool is subject to multiple terms of service/use and privacy policies - see here for more details.
Submit an article to us!
DOW 16,979.13 +59.54 0.35%
S&P 500 1,986.51 +4.91 0.25%
NASDAQ 4,526.4820 -1.0320 -0.02%

Brokerage Partners

Rates from Bankrate.com

  • Mortgage
  • Credit Cards
  • Auto

Free Newsletters from TheStreet

My Subscriptions:

After the Bell

Before the Bell

Booyah! Newsletter

Midday Bell

TheStreet Top 10 Stories

Winners & Losers

Register for Newsletters
Top Rated Stocks Top Rated Funds Top Rated ETFs