Smoking a Factor in TKA Revision

The most important factor associated with a risk of revision following total knee arthroplasty (TKA) is smoking, according to Pam Harrison, a contributing writer for MedPage Today. Benedict Nwachukwu, M.D., of the Hospital for Special Surgery in New York City, and colleagues in BMC Musculoskeletal Disorders reported that smoking was associated with a nearly threefold increased risk.

The study was a sizeable one. It covered 430 patients who had undergone TKA at a tertiary center over a 13-year period—146 who had undergone both a primary and revision TKA and 290 patients with a primary TKA without an identified revision. While the male gender was associated with risk of revision, older age patients were associated with a 17% lower risk of requiring revision for each five year increase in age.

The only technical factor that increased the risk of revision was the receipt of a lateral release, which increased revision risk by 92%, according to Harrison. (Lateral release during TKA is defined as a surgical technique whereby tight lateral soft tissue structures of the knee are released.)

The researchers wrote that, “The increasing utilization of primary TKA is projected to result in substantial increases in demand for revision TKA which was performed on over 54, 000 persons in the U.S. in 2012.” They added, “Given the procedural complexity of revision procedures, growth in utilization of revision TKAs will further strain healthcare resources.”

In other words, tell potential TKA recipients they must stop smoking.