Abstract
Numerous studies have described a correlation between smoking and reduced bone mass. This not only increases fracture risk but also impedes reconstruction/fixation of bone. An increased frequency of complications following surgery is common. Here, we investigate the effect of smoking on the clinical outcome following total joint arthroplasty (TJA). 817 patients receiving primary or revision (including clinical transfers) TJA at our level-one trauma center have been randomly interviewed twice (pre- and six months post-surgery). We found that 159 patients developed complications (infections, disturbed healing, revisions, thrombosis, and/or death). Considering nutritional status, alcohol and cigarette consumption as possible risk factors, OR was highest for smoking. Notably, mean age was significantly lower in smokers (59.2 ± 1.0a) than non-smokers (64.6 ± 0.8; p < 0.001). However, the number of comorbidities was comparable between both groups. Compared to non-smokers (17.8 ± 1.9%), the complication rate increases with increasing cigarette consumption (1–20 pack-years (PY): 19.2 ± 2.4% and >20 PY: 30.4 ± 3.6%; p = 0.002). Consequently, mean hospital stay was longer in heavy smokers (18.4 ± 1.0 day) than non-smokers (15.3 ± 0.5 day; p = 0.009) or moderate smokers (15.9 ± 0.6 day). In line with delayed healing, bone formation markers (BAP and CICP) were significantly lower in smokers than non-smokers 2 days following TJA. Although, smoking increased serum levels of MCP-1, OPG, sRANKL, and Osteopontin as well as bone resorption markers (TRAP5b and CTX-I) were unaffected. In line with an increased infection rate, smoking reduced 25OH vitamin D3 (immune-modulatory), IL-1β, IL-6, TNF-α, and IFN-γ serum levels. Our data clearly show that smoking not only affects bone formation after TJA but also suppresses the inflammatory response in these patients. Thus, it is feasible that therapies favoring bone formation and immune responses help improve the clinical outcome in smokers following TJA.
Highlights
Smoking indisputably affects human health, e.g. increases the risk of cancers, cardiovascular and respiratory diseases, reproductive problems, and other medical maladies
Our data confirm that smoking is a major risk factor for complications following total joint arthroplasty (TJA), even at an early age
Smokers should be encouraged to abstain from smoking to improve the outcome of orthopedic surgeries, especially while no specific treatment strategies are available for these patients
Summary
Smoking indisputably affects human health, e.g. increases the risk of cancers, cardiovascular and respiratory diseases, reproductive problems, and other medical maladies. A correlation between cigarette consumption and reduced bone mass was described for the first time in 1976 [1]. This correlation has been confirmed in several epidemiologic studies since [2,3]. Smokers frequently show delayed fracture healing, higher frequency of complications, and prolonged hospital stays as compared to non-smokers [8,9]. This might be partly due to alterations in bone density and structure, which in turn impede reconstruction and fixation of the bone. The underlying mechanisms affecting bone quality are not yet fully understood
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