ArticleActa orthopaedica2019
The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients.
Article in Acta orthopaedica, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
46 citing papers in PubMed, 4 syntheses or guidelines pooled it, 94 citations in OpenAlex.
- The effect of non-tobacco nicotine on bone healing: a systematic review and application to total joint arthroplasty.Journal of orthopaedic surgery and research · 2026Pooled it
- The impact of electronic cigarettes on the outcomes of total joint arthroplasty.Archives of orthopaedic and trauma surgery · 2024Pooled it
- Impact of smoking on the incidence and post-operative complications of total knee arthroplasty: A systematic review and meta-analysis of cohort studies.Bosnian journal of basic medical sciences · 2022Pooled it
- Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review.International journal for equity in health · 2021Pooled it
- Do smokers achieve the same clinically meaningful improvement after total hip arthroplasty?European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Characterizing Comorbidities in Total Joint Arthroplasty in a Safety-Net Hospital Using Age-Adjusted Charlson Comorbidity Index.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026Article
- A Carbon Monoxide Breathalyzer is Effective at Identifying Smokers Before Total Joint Arthroplasty.Arthroplasty today · 2026Article
- Article
- Impact of Smoking Status on Early Outcomes and Healthcare Utilization Following Primary Total Knee Arthroplasty: A Retrospective Cohort Study.The Journal of arthroplasty · 2026Article
- What is the Association Between Nontobacco Nicotine Dependence and Postoperative Complications in Total Hip Arthroplasty? A Large Propensity-Matched Cohort Study.Arthroplasty today · 2025Article
- The impact of "weekend effect" on the outcomes of total joint arthroplasty in the United States.International orthopaedics · 2025Article
- Higher bone cement volume in total knee arthroplasty lowers the risk of postoperative radiolucent lines.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Article
- The effect of tobacco use on clinical outcomes in total knee arthroplasty patients.Proceedings (Baylor University. Medical Center) · 2025Article
- Active Amphetamine Abuse in Total Hip Arthroplasty Carries Increased Risk for Postoperative Surgical and Medical Complications.Arthroplasty today · 2024Article
- Total knee arthroplasty following lateral closing-wedge high tibial osteotomy versus primary total knee arthroplasty: a propensity score matching study.Journal of orthopaedic surgery and research · 2024Article
- Risk factors for in-patient myocardial infarction following total hip arthroplasty.Journal of orthopaedics · 2024Article
- Patients' experience on pain outcomes after hip arthroplasty: insights from an information tool based on registry data.BMC musculoskeletal disorders · 2024Article
- Article
- Smoking is associated with higher short-term risk of revision and mortality following primary hip or knee arthroplasty: a cohort study of 272,640 patients from the Dutch Arthroplasty Registry.Acta orthopaedica · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background and purpose - Smoking is a modifiable risk factor that may adversely affect postoperative outcomes. Healthcare providers are increasingly denying smokers access to total hip and knee arthroplasty (THA and TKA) until they stop smoking. Evidence supporting this is unclear. We assessed the effect of smoking on outcomes following arthroplasty.Patients and methods - We identified THAs and TKAs from the Clinical Practice Research Datalink, which were linked with datasets from Hospital Episode Statistics and the Office for National Statistics to identify outcomes. The effect of smoking on postoperative outcomes (complications, medications, revision, mortality, patient-reported outcome measures [PROMs]) was assessed using adjusted regression models.Results - We studied 60,812 THAs and 56,212 TKAs (11% smokers, 33% ex-smokers, 57% non-smokers). Following THA, smokers had an increased risk of lower respiratory tract infection (LRTI) and myocardial infarction compared with non-smokers and ex-smokers. Following TKA, smokers had an increased risk of LRTI compared with non-smokers. Compared with non-smokers (THA relative risk ratio [RRR] = 0.65; 95% CI = 0.61-0.69; TKA RRR = 0.82; CI = 0.78-0.86) and ex-smokers (THR RRR = 0.90; CI = 0.84-0.95), smokers had increased opioid usage 1-year postoperatively. Similar patterns were observed for weak opioids, paracetamol, and gabapentinoids. 1-year mortality rates were higher in smokers compared with non-smokers (THA hazard ratio [HR] = 0.37, CI = 0.29-0.49; TKA HR = 0.52, CI = 0.34-0.81) and ex-smokers (THA HR = 0.53, CI = 0.40-0.70). Long-term revision rates were not increased in smokers. Smokers had improvement in PROMs compared with preoperatively, with no clinically important difference in postoperative PROMs between smokers, non-smokers, and ex-smokers.Interpretation - Smoking is associated with more medical complications, higher analgesia usage, and increased mortality following arthroplasty. Most adverse outcomes were reduced in ex-smokers, therefore smoking cessation should be encouraged before arthroplasty.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.