Published on October 23, 2017

Want a better joint replacement outcome? Quit smokingWant a better joint replacement outcome? Quit smoking

While preparing for your much-needed joint replacement surgery, after months or years of pain and discomfort, you might want to add quitting smoking to your pre-op plan.

Smoking can interfere with healing after a replacement procedure because it inhibits the cellular repair processes and slows down the oxygen-rich blood flow that helps heal and prevent infection.

“The two biggest causes of joint replacement failures are sepsis (infection that spreads through the bloodstream) and loosening of the prosthesis, both of which, are impacted by smoking,” said Robert Wilsterman, MD, an orthopedic surgeon at Falmouth Hospital.

Those who smoke tobacco have a much greater risk of wound infections than non-smokers, he said.

A recent study published in the Journal of Bone & Joint Surgery concluded that “current smokers have a significantly increased risk of reoperation for infection within 90 days of a surgical procedure compared with non-smokers.”

The researchers identified more than 15,000 patients who underwent total joint replacements between 2000 and 2014. Of that number, 1,371 were smokers at the time of surgery, 5,195 were former smokers and 8,698 were non-smokers.

The overall risk of infections within 90 days was 0.71 percent, yet for smokers the risk spiked to 1.2 percent compared to non-smokers at 0.56 percent. The researchers made adjustments for other factors and concluded that a smoker’s risk was 80 percent higher than non-smokers and former smokers.

“Smoking decreases circulation in the small blood vessels and constricts them,” Dr. Wilsterman said. “The nutrients, cells, and oxygen that need to get to the area for healing are hindered, which leads to a lesser ability to fight infection.”

A 2015 study published by National Institute for Biotechnical Information (NCBI) revealed that smoking increased the risk of aseptic (contaminant-free) loosening of the hip prosthesis compared to patients who didn’t smoke. The only way to repair the prosthetic is another surgical procedure to replace the original components.

The good news is that positive changes in the body can be seen soon after someone quits smoking. Another study published by NCBI in 2012 stated that tissue repair and cellular functions return within four weeks of quitting smoking. The proliferative phase of healing, which is when new connective tissue and small blood vessels begin to form, may take longer to repair.

Dr. Wilsterman said he implores his patients to quit smoking before surgery and is more than willing to tailor their surgical date to allow them time to quit. He recommends that patients who are considering quitting the smoking habit discuss it with their primary care physician who can prescribe the appropriate medication to help them.