Smoking and Knee Replacement – Jeffrey R. Carlson, MD

Orthopaedic & Spine Center

Just in case you needed something else to convince you…more evidence is mounting, and continues to come out almost every month, concerning the harmful effects of smoking on a person’s health. As an orthopaedic surgeon, I am always concerned about how my patients will heal after having surgery and I want to know if there are any medical issues or health habits that will impact that post-surgery healing. Healing rates after surgery are always critical to anyone having a bone-related surgery. Anything that may slow healing is to be avoided if at all possible. I inform patients of the need to quit smoking, perform daily exercise and eat nutritious foods, BEFORE considering surgery. Smoking, however, is always the hardest issue to overcome with my patients. Obviously, there are significant physical dependencies that make it difficult for patients to stop smoking quickly. For some patients, kicking an addiction to nicotine is just as hard as giving up as an addition to hard drugs, like heroin or morphine. Patients that smoke also find emotional solace in lighting up, and use smoking as a way of comforting themselves as they face the trauma of surgery and recovery.

New research out of Baltimore, Maryland, presented in February 2012, looked at patients who smoked and had knee replacements while continuing to smoke. All of the patients in the study were encouraged to quit smoking, but the study found that this rarely happened. The researchers looked at the data for every patient who had total knee replacements done between 2005 and 2009. They divided the group into “smokers” and “non-smokers”. With a follow-up of 5 years, only 91% of the smokers had a functioning knee replacement while 96% of the “non- smokers” had a functioning knee replacement. Even those patients that had stopped smoking prior to their knee surgery had better outcomes than those that continued to smoke through their recovery.

Smoking decreases healing due to a slowing of blood flow throughout the body. As our blood supply is what carries nutrition to our body tissues, those areas that are in need of increased nutrition will need increased blood supply. Post-surgical sites, especially bone and skin tissue, need extra oxygen and minerals to heal properly. Smoking is known to decrease the rate of bone fracture healing, leading to either a more slowly-healing fracture or a fracture that doesn’t heal at all. This new study also shows the effect of smoking on the healing around metal that bone is trying to incorporate, as in a spinal fusion or knee or hip replacement. Orthopaedic surgeons use plates, screws and rods to keep the bones in alignment and eliminate the need for casting, but the patient’s body still needs to provide its own miraculous healing powers to the surgical site for the patient to fully thrive and recover from surgery.

If you are considering an orthopaedic surgery, it is important that you discuss your smoking habit with your surgeon. He or she can help you learn about ways to quit or minimize your need for tobacco BEFORE your surgical procedure, maximizing your chances for a great outcome and recovery.

Dr. Jeffrey R. Carlson is a Harvard Orthopaedic/Neurosurgical Spine Fellow. He is the Managing Partner of and currently practices at Orthopaedic and Spine Center in Newport News, VA. Dr. Carlson has been voted a Hampton Roads “Top Doc” for 2012, 2013 and 2014, in a physician survey conducted by Coastal Virginia Magazine. For more information or for an appointment, contact OSC at 757-596-1900 or go to