Boyd W. Haynes III, MD
As a busy orthopedic surgeon in Newport News, I’ve performed more hip replacement surgeries than I can count over the years, with a good percentage of them having been done on smokers. While both smokers and nonsmokers typically recover well, there are differences during the pre- and post-surgical recovery period between the two that are worth noting. In this article, I’ll discuss the risks of which smokers should be aware when considering a hip replacement surgery, so they can make an informed decision.
Unless you’ve been living under a rock for the last 70 years, I don’t need to tell you about the dangers of smoking. While you may be well aware of lung cancer, emphysema, COPD, and chronic bronchitis, you may not be aware that smoking is the number one reason for post-surgical complications, like infection, poor wound healing and poor surgical outcomes for knee and hip replacements. This is due to smoking’s effects on oxygen circulation through the blood to operated tissues, increased pre- and post- surgical pain due to smoking, and a variety of other smoking related sequelae. It would take you a week or more to read all the clinical studies that state the same evidence – smoking is harmful for patients having orthopaedic surgeries!
One particular danger that smoking represents is to the hip. Specifically, to the head of the femur, which is the end of the long bone in the thigh that reaches from the knee to the hip socket. The head of the femur, which rests in the hip socket, is especially prone to damage from smoking. This damage is a condition called Avascular Necrosis and smoking is the one of the leading causes for it, right behind alcohol abuse. In Avascular Necrosis, blood flow to the head of the femur is interrupted, because the channels carrying blood in the bone become blocked by fatty deposits. The bone tissue begins to starve, becomes necrotic and eventually dies, due to a lack of blood flow. Avascular Necrosis (AVN) can even be the reason for a smoker needing to have a hip replacement surgery in the first place, instead of the more commonly seen arthritis.
When a patient who’s a smoker comes to me for a hip replacement consultation, I counsel them to consider quitting smoking at once, if at all possible. If the patient cannot agree to this, I ask that they try and quit at least two to six weeks before the surgery to give the lungs some opportunity to heal, for circulation to improve and for body tissues to become more oxygenated. I also ask they try to remain smoke-free for at least two weeks afterward, during recovery. I am happy to work with a patient and their PCP in any way to accommodate quitting smoking efforts, including hypnosis, medication patches, gum, nasal sprays, etc.
As a final word – smokers can and do have successful hip replacement surgeries every day. However, I would be remiss if I didn’t let my patients know the risks before going into surgery. As your Orthopaedic Surgeon, I will do my best to ensure you have the best outcome for your surgery, working with you as my teammate.