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Smoking Increases Risk of Infection in Joint Replacement Surgery

Smoking Increases Risk of Infection in Joint Replacement Surgery

Study Links Smoking to Higher Risk of Reoperation for Infection in Joint Replacement Patients

Patients undergoing surgery for a total knee or hip replacement are more likely to undergo a second surgery due to infection if they are smokers, research suggests. A study published in the February 15, 2017 issue of The Journal of Bone & Joint Surgery found that smoking increases the risk of infectious (septic) complication requiring an additional surgery in joint replacement patients. Smoking was associated with an 80 percent increased risk, researchers found.

The product liability lawyers at Parker Waichman LLP have decades of experience representing clients in lawsuits over allegedly defective or dangerous products. The firm continues to offer free legal consultations to individuals with questions about filing a joint replacement lawsuit, including hip replacement and knee replacement lawsuits.

Researchers conducted the study by analyzing data from 15,264 patients who underwent a total of 17,394 joint replacement surgeries between 2000 and 2014. The joint replacement procedures included 8,917 hip replacements and 8,477 knee replacements. Authors studied the relationship between smoking history and hospital readmissions to determine if there was an association.

The senior author of the study was Dr. Matthew S. Austin of the Rothman Institute at Thomas Jefferson University, Philadelphia. "Our results found that current smokers had a significantly higher rate of septic reoperation compared with nonsmokers," he commented in a February 15, 2017 press release. "Furthermore, each additional pack-year significantly contributed to total reoperations." A pack year is calculated by multiplying the number of packs of cigarettes smoked daily by the number of years the individual has smoked. For example, a one pack-year represents an individual who smokes 20 cigarettes, or one pack, per day for one year, or 40 cigarettes daily for six months.

Patients were categorized into one of three groups: Current smokers, former smokers, and nonsmokers. These groups comprised nine percent, 34 percent, and 57 percent of the study population, respectively. The average age of nonsmokers was roughly 58 years compared to 63 years for smokers. Certain major respiratory and cardiovascular diseases appeared more in smokers when compared to nonsmokers.

Within 90 days of joint replacement surgery, the absolute risk of reoperation for infectious complications (undergoing a second surgery for a serious infection) was 0.71 percent. This risk is low, but it was significantly higher in patients who smoke. The risk with current smokers was 1.2 percent. Comparatively, the risk with nonsmokers was 0.56 percent.

Smoking was still linked to an increased risk of reoperation for infectious complications after researchers accounted for other factors that could have contributed to the results. After adjusting for these characteristics, the relative risk for smokers was 80 percent higher compared to nonsmokers. The study did not find an increased risk among the group of former smokers.

Smoking May Cause Infections in Joint Replacement Surgery

Authors found that the number of cigarettes smoked in the past ("pack-years") was associated with a higher risk of nonoperative readmission to the hospital within 90 days, in both smokers and former smokers. The relative risk jumps up by twelve percent in participants smoking an extra pack per day for a decade. The study did not find a link between smoking overall and readmission without surgery or reoperation for reasons other than infection.

The authors note that previous studies have not established a clear relationship between smoking and joint replacement surgery complications. "The purpose of this study was to investigate the association between smoking and readmission and/or reoperation within 90 days of total joint arthroplasty in a large, non-select cohort of patients," researchers write.

The findings suggest that joint replacement patients have a higher risk of undergoing reoperation for infection if they are current smokers. Both current and former smokers had a higher risk of being readmitted to the hospital without operation.

Further research is needed to determine whether quitting smoking would lower the risk of complications. The authors write, "If smoking is associated with elevated perioperative risk of readmission and/or reoperation, then it may be reasonable to engage the patient in a smoking cessation program prior to total joint arthroplasty."

The researchers concluded that, "This study, after controlling for confounding factors, demonstrated not only that current smokers have a significantly increased risk of reoperation for infection within 90 days of a surgical procedure compared with nonsmokers, but also that the amount that one has smoked, regardless of current smoking status, significantly contributed to increased risk of nonoperative readmission."

Metal-on-Metal Hip Replacements: Background

Parker Waichman notes that-with or without consideration of smoking behavior-certain joint replacement devices are associated with an increased risk of complications and subsequent reoperation. Concerning hip replacements, for example, metal-on-metal hip implants have become controversial because they are associated with a higher rate of revision surgery. Hip implants are expected to last at least 10 to 15 years, but some patients with metal-on-metal hip implants have undergone revision surgery due to complications within a few short years. The issue with metal-on-metal hip implants, experts have found, is that the metal surfaces may grind against one another, shedding metallic debris into the body.

Complications associated with metal-on-metal hip implants may include pain, swelling, inflammation, tissue death, bone damage, and metallosis (metal poisoning).

Concerns over metal-on-metal hip implants came into the public sphere in 2010, when Johnson & Johnson's DePuy unit issued a worldwide recall for its ASR hip implants due to an unexpectedly high rate of early failure. Since then, thousands of lawsuits have been filed against DePuy, as well as other metal-on-metal hip makers. Metal-on-metal hip implant lawsuits have also been filed against Stryker Orthopaedics, Wright Medical, Smith and Nephew, and other manufacturers.

In 2013, the U.S. Food and Drug Administration (FDA) convened an expert panel to discuss the risks of metal-on-metal hip implants. The FDA Orthopaedic and Rehabilitation Devices Advisory Panel warned of "unique risks" associated with metal hip replacements, stating "In metal-on-metal hip implants, the metal ball and the metal cup slide against each other during walking or running. Metal can also be released from other parts of the implant where two implant components connect. Metal release will cause some tiny metal particles to wear off of the device around the implant, which may cause damage to bone and/or soft tissue surrounding the implant and joint. This is sometimes referred to as an 'adverse local tissue reaction (ALTR)' or an 'adverse reaction to metal debris (ARMD).'"

Knee Replacement Injuries: Background

Lawsuits have also been filed over allegedly defective knee replacement implants. There have been safety concerns and litigation related to DePuy knee replacements, Zimmer NexGen knee implants, Stryker knee replacements, and other devices.

In 2016, Stryker Corporation agreed to pay $7.6 million to settle product liability lawsuits alleging injuries from its Duracon Unicompartmental Knee implant (also known as the Uni-Knee). The settlement, which resolved 70 knee implant lawsuits, ended nearly 15 years of litigation.

Consideration of smoking habits was not a consideration regarding knee replacement injuries and replacements.

Filing a Medical Device Injury Lawsuit

Parker Waichman has years of experience representing clients in medical device injury lawsuits. If you or someone you know is interested in filing a hip or knee replacement injury lawsuit, contact one of our experienced product liability lawyers today. Our firm offers free, no-obligation case evaluations. For more information, fill out our online form or call 1-800-YOURLAWYER (1-800-968-7529).


Smoking Increases Risk of Infection in Joint Replacement SurgeryRSS Feed

Reoperation Risk due to Post-Surgery Infection Increase for Smokers

Feb 17, 2017
According to a study in The February 15, 2017 issue of The Journal of Bone & Joint Surgery, smoking is linked to an increased risk of infectious (septic) complications requiring repeat surgery for individuals undergoing total knee or hip replacement. "Our results found that current smokers had a significantly higher rate of septic reoperation compared with nonsmokers," remarked senior author Dr. Matthew S. Austin of the Rothman Institute at Thomas Jefferson University, Philadelphia....

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