Leg Vein Health

10 April 2017

Smokers have 80% higher complication risk after joint surgery

A study found that smokers have a higher risk of hospital readmission after total hip or knee replacements than non-smokers.


The prognosis for a hip or knee replacement is usually good, but there may be problems with infection, loosening or sometimes dislocation of the prosthesis.  

A small number of patients develop an infection after the surgery, and the risk is for developing an infection is greater in patients who smoke, researchers report.

They analysed data from more than 15 000 patients who underwent either total hip or knee replacements between 2000 and 2014. The investigators found that the overall risk of repeat surgery for infections within 90 days was only 0.71%.

Smoking-cessation programmes

However, the risk was 1.2% for current smokers, compared with 0.56% for non-smokers. After adjusting for other factors, the researchers concluded that current smokers' risk was 80% higher than non-smokers and former smokers.

In South Africa there is good news: According to the latest national statistics, in 2012 only16.4% of South Africans were smokers, compared to 32% in 1993. This has been attributed to stricter smoking legislation, advertising limitations and steeper tobacco prices.

The researchers also found that for both current and former smokers, the risk of 90-day hospital readmission not involving surgery rose with the number of "pack-years" smoked – a calculation of the number of packs smoked per day over a number of years. Smoking an extra pack a day for a decade was associated with a 12% increased risk.

However, the study only found a link between smoking and greater risk for complications after knee or hip surgery, not cause-and-effect.

The study was published recently in The Journal of Bone & Joint Surgery.

The findings suggest it may be a good idea to enroll patients in smoking-cessation programmes before they have total joint replacement, Dr Matthew Austin, from Thomas Jefferson University in Philadelphia, and colleagues wrote.

But they added that further research is needed to confirm whether quitting smoking before joint replacement surgery reduces the risk of complications.

Read more:

Occasional smoking damaging

Smoking alternatives

Passive smoking


Ask the Expert

Leg vein expert

Dr. Riaz Motara is a specialist physician and cardiologist. He has an interest in preventative cardiology. He runs Veinsculpt, the first and only comprehensive vein clinic in South Africa, using endo-venous laser ablation as the treatment of choice.He also operates the only Women's Heart Clinic in South Africa.

Still have a question?

Get free advice from our panel of experts

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

* You must accept our condition

Forum Rules