Limited strength evidence supports that patients who use tobacco products are at an increased risk for complications after total hip arthroplasty.


Two low-quality studies (Sadr et al and Huddleston et al) examined the complication rates of THA patients who smoked tobacco compared with those who did not. One of the studies (Sadr) found a significant increase in perioperative complications in heavy tobacco users, and a 43% increase in complications in those who previously used tobacco, which rose to 56% for current tobacco users. However, Huddleston et al showed no increase in complications among THA patients who smoked tobacco when compared with those who did not.

The detrimental effects of smoking on wound healing, pulmonary function, and the immune system are well accepted.  While the evidence to require patients to cease smoking prior to THA consisted of low-quality studies, educating and engaging patients in the health benefits of smoking cessation remains a priority.

  1. Huddleston,J.I.; Wang,Y.; Uquillas,C.; Herndon,J.H.; Maloney,W.J. Age and obesity are risk factors for adverse events after total hip arthroplasty. Clin Orthop Relat Res; 2012/2: 2
  2. Sadr,Azodi O.; Bellocco,R.; Eriksson,K.; Adami,J. The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement. J Bone Joint Surg Br; 2006/10: 10