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You may not expect an orthopedic surgeon to provide you with smoking cessation counseling, but recent studies have shown that patients that use nicotine products have more complications with both surgical and non-surgical treatment options available to them.

We have all heard that smoking decreases ones life expectancy.  Smoking can additionally be the cause of lung cancer or disease, heart disease, and increase ones risk of stroke. But did you know that smoking also decreases wound healing, bone healing, and increase the chance of a blood clots?

If you are planning to have a joint replacement surgery, your physician will likely recommend smoking cessation counseling prior to your surgery.

During a joint replacement surgery, your surgeon and technicians are very careful to work in a sterile field.  This is to aid in preventing infection around your new joint. However, studies have shown that smoking can delay wound healing which can cause complications, including an infection. 

While an infection around a joint replacement is rare, it could lead to prolonged post-operative care, or even surgical intervention to treat the aftermath of an infection. 

Many implants used in joint replacements today are designed to allow the bone to grow around the implant to ensure stability. Studies have shown patients who smoke to have a higher failure rate including periprosthetic fractures and failure of bone growth into the implant. Smoking has been shown to decrease the blood supply to bones, slow the production of bone-forming cells, decrease absorption of calcium, and cause estrogen in the body to break down more quickly. Estrogen is important in both men and women for a strong skeleton. If the implant fails to in-grow properly, this can cause the implant to be loose and increase pain. To resolve an implant that failed to grow in fully, a revision surgery may be necessary.

Following a joint replacement surgery, patients will be placed on a blood thinner and given compression stockings to help decrease risk of deep vein thrombosis following surgery. A deep vein thrombosis or DVT is a serious condition when a blood clot develops in a deep vein within the body. 

This type of blood clot can break off, travel to the lungs, and cause a pulmonary embolism which could be fatal. Smoking has also been shown to increase risk of developing a DVT, especially following a joint replacement surgery.

If you are considering a total joint replacement as a long-term solution to arthritis, don’t be surprised if your surgeon recommends quitting smoking prior to proceeding with surgery.

Author: Robin Dodd

References:

DVT and Smoking

http://www.ucihealth.org/medical-services/orthopaedics/hip-knee-surgery-services/deep-vein-thrombosis

https://orthoinfo.aaos.org/en/staying-healthy/smoking-and-musculoskeletal-health

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm

https://www.abstractsonline.com/Plan/ViewAbstract.aspx?mID=2841&sKey=8f07675f-aadf-4b0b-baed-e7aabc4b0f69&cKey=9f6adec0-3e90-4ac0-bc8e-16863e63f68d&mKey=%7bBA8AA154-A9B9-41F9-91A7-F4A4CB050945%7d

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