Planning a Knee Replacement, But You Smoke

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Total knee replacement has become a very common procedure for the treatment of knee arthritis. This surgery is generally safe and when properly performed provides predictable and durable results. However, there are patients that are smokers or use nicotine products that may impact the outcome of the procedure.

Make sure you let us know if are a smoker or use nicotine products

Nicotine exposure from cigarette smoking, chewing tobacco, or other parenteral sources have been associated with increased risk of delayed wound healing, surgical site infection, deep periprosthetic joint infection, aseptic loosening, and increased length of stay after total joint arthroplasty. Cigarette smoke exposes the patient to carbon monoxide reducing peripheral tissue oxygen delivery and nicotine metabolites result in catecholamine release resulting in vasospasm of peripheral blood vessels. The toxins in cigarette smoke also affect the immune system by slowing white blood cells ability to fight infection. Smoking can impair the wound-healing pathway resulting in poor tensile strength of scar tissue and risk of infection.

Can you reduce the risk of smoking

Smoking cessation and avoidance of nicotine products 1 month prior to joint replacement surgery and continued abstinence for 1 month after surgery can result in a relative risk reduction of 50%.

What you need to do

Patients should report if they are smokers or active users of nicotine products.

Active smokers will be counseled on the risks of smoking and will agree to stop smoking or using nicotine products 1 month prior to surgery and continue avoidance for at least 1 month following surgery.

Those patients who are unable to discontinue use of nicotine products may be referred to a smoking cessation program, and may have their surgery postponed. Blood or urine testing for nicotine at least 2 weeks prior to surgery to confirm compliance with cessation may be considered for non- compliant patients.