LIMITED RECOMMENDATION Eleven low quality studies (Burn 2019, Sali 2020, Sadr Azodi 2006, Peters 2020, Huddleston 2012, Gonzalez 2018, Sirignano 2023, Lung 2023, Peters 2021, Benes 2023, Goh 2022) were reviewed. There is a lack of clarity in the literature regarding different forms of tobacco use. Smoking is widely considered to be more significant than other forms of tobacco use. Most of the studies have investigated the effect of smoking on surgical outcome. One low quality study (Sadr Azodi 2006) showed increased systemic complications in both current and former smokers, while another prospective study (Gonzalez 2018) showed increased PJI in current and former smokers. There is a lack of clarity in literature regarding different forms of tobacco use. Lung (2023) reported that smoking is an independent risk factor for sustaining periprosthetic fracture.
Benefits/Harms of Implementation
There could be significant potential harm due to systemic complications and increased periprosthetic joint infections in smokers after total hip arthroplasty. It will result in significant financial burden and medical comorbidities. There is no benefit of smoking in patients undergoing total hip arthroplasty however, in absence of strong data, there is a concern about denial of care impatience with the smoking.
Outcome Importance
Future research will help us understand the impact of smoking on total hip arthroplasty. Postoperative complications could have a significant impact on the patient under community.
Cost Effectiveness/Resource Utilization
Any postoperative complication after total hip arthroplasty requires intense resource utilization and leads to increased cost of care.
Acceptability
There is no barrier to the acceptability of this option. Physicians should have open discussions with patients about potential downside.
Feasibility
This option does not contradict the current standard of care.
Future Research
Future well designed studies examining the effects of different forms of tobacco on the postoperative short- and long-term outcomes after total hip arthroplasty are needed. Stratification into the amount of tobacco use and those effects on outcomes are also needed. Future healthcare costs studies are also needed to determine the financial impact of tobacco use and complications after total hip arthroplasty.
- Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Prieto-Alhambra, D., Pinedo-Villanueva, R.. (2019). The impact of BMI and smoking on risk of revision following knee and hip replacement surgery: evidence from routinely collected data. Osteoarthritis & Cartilage, 27(9), 1294-1300.
- Sali, E., Marmorat, J. L., Gaudot, F., Nich, C.. (2020). Perioperative complications and causes of 30- and 90-day readmission after direct anterior approach primary total hip arthroplasty. Journal of Orthopaedics, 17(0), 69-72.
- Sadr Azodi, O., Bellocco, R., Eriksson, K., Adami, J.. (2006). 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. Journal of Bone & Joint Surgery - British Volume, 88(10), 1316-20.
- Peters, R. M., van Steenbergen, L. N., Stewart, R. E., Stevens, M., Rijk, P. C., Bulstra, S. K., Zijlstra, W. P.. (2021). Which patients improve most after total hip arthroplasty? Influence of patient characteristics on patient-reported outcome measures of 22,357 total hip arthroplasties in the Dutch Arthroplasty Register. Hip International, 31(5), 593-602.
- 11. Benes, Gregory A., Dasa, Vinod, Krause, Peter C., Jones, Deryk G., Leslie, Lauren J., Chapple, Andrew G.. (2023). Disparities in Elective and Nonelective Total Hip Arthroplasty. The Journal of arthroplasty, 0(0), . http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medp&NEWS=N&AN=36690188 .
- Goh, G. S., Tarabichi, S., Baker, C. M., Qadiri, Q. S., Austin, M. S.. (2022). Should We Aim to Help Patients "Feel Better" or "Feel Good" After Total Hip Arthroplasty? Determining Factors Affecting the Achievement of the Minimal Clinically Important Difference and Patient Acceptable Symptom State. Journal of Arthroplasty, 12(0), 12.
- Huddleston, J. I., Wang, Y., Uquillas, C., Herndon, J. H., Maloney, W. J.. (2012). Age and obesity are risk factors for adverse events after total hip arthroplasty. , 470(2), 490-6.
- Gonzalez, A. I., Luime, J. J., Uçkay, I., Hannouche, D., Hoffmeyer, P., Lübbeke, A.. (2018). Is There an Association Between Smoking Status and Prosthetic Joint Infection After Primary Total Joint Arthroplasty?. Journal of Arthroplasty, 33(7), 2218-2224.
- Sirignano, Michael, Nessler, Joseph M., Rhea, Evan B., Ong, Kevin L., Watson, Heather, Yakkanti, Madhusudhan R., Malkani, Arthur L.. (2023). "Incidence of Instability Following Primary Total Hip Arthroplasty Continues to Decline in the Medicare Population". The Journal of arthroplasty, 0(0), . http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medp&NEWS=N&AN=37088227
- Lung, Brandon E., Donnelly, Megan, Callan, Kylie, McLellan, Maddison, Amirhekmat, Arya, McMaster, William C., So, David H., Yang, Steven. (2023). Preoperative Malnutrition and Metabolic Markers May Predict Periprosthetic Fractures in Total Hip Arthroplasty. Arthroplasty Today, 19(0), 101093. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=pmnm&NEWS=N&AN=36691463
- Peters, R. M., van Steenbergen, L. N., Stewart, R. E., Stevens, M., Rijk, P. C., Bulstra, S. K., Zijlstra, W. P.. (2021). Which patients improve most after total hip arthroplasty? Influence of patient characteristics on patient-reported outcome measures of 22,357 total hip arthroplasties in the Dutch Arthroplasty Register. Hip International, 31(5), 593-602.