Background/Purpose: Total knee and hip arthroplasty (TKA and THA) are very common surgeries performed in patients who suffer from pain and functional limitation due to symptomatic arthritis, when medical management has failed. These surgeries are usually elective, and are associated with excellent outcomes including significant improvement in function, quality of life and reduction in pain severity. Smoking is a modifiable risk factor for patients failing to improve dramatically after a Total Hip Arthroplasty or Total Knee Arthroplasty surgeries. Our objective was to assess the benefits and harms of perioperative smoking cessation interventions on outcomes and complications after knee or hip replacement.

Methods: An expert librarian searched six databases for any clinical trials of relevance, including the Cochrane Central Register of Controlled Trials (CENTRAL), OVID MEDLINE, CINAHL, EMBASE, Science Citation Index and Current Controlled Trials databases. Studies were included if they used perioperative smoking cessation as an intervention in patients undergoing TKA/THA, were randomized or quasi-randomized and provided clinical outcomes. Two review authors independently reviewed all titles and abstracts, selected appropriate studies for full review and reviewed the full-text articles for the final selection of included studies. For each study, they independently abstracted study characteristics, safety and efficacy data and performed risk of bias assessment. Disagreements were resolved by consensus. The primary outcomes of interest were wound complications, revision or reoperation rate, any postoperative complication within 30-days of the surgery, venous thromboembolism, death, function: as assessed by validated outcome and pain.

Results: Three RCTs with 311 participants were included that had the data for the outcomes comparing Counselling/Nicotine replacement versus No counselling/Smoking cessation program. The outcomes of interest found to be statistically significantly associated with Smoking cessation interventions were postoperative complications within 30 days of arthroplasty(OR= 0.23) and smoking cessation after surgery (4 weeks,OR= 9.06; 1 year,OR= 6.5; after 1 year, OR= 0.15). Detailed data results are shown in Table. 1

Conclusion: With an overall high grade of evidence, Perioperative smoking cessation therapy is significantly more efficacious than placebo in preventing incidence of complications after knee or hip replacement. Long-term surveillance studies are needed for safety assessment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/perioperative-interventions-for-smoking-cessation-in-hip-and-knee-arthroplasty-for-osteoarthritis-and-other-non-traumatic-diseases/