Another reason to put down the cigarette before the surgeon picks up the scalpel. New work from Duke University Medical Center and the Medical University of South Carolina has found that smokers undergoing total ankle replacement (TAR) fared much worse than their non-or-never-smoker cohorts.
Smokers Undergoing TAR: Prepare for Complications
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Alexander Lampley, M.D. is with the Department of Orthopaedic Surgery at Duke. He told OTW, “While the negative effects of tobacco use have been demonstrated in the hip and knee arthroplasty literature, no study has previous examined the effect of cigarette smoking on complications or functional outcome scores after total ankle arthroplasty.”
“We examined the records of 642 smokers who had TAR between June 2007 and February 2014. The patients were separated into three groups based on their smoking status: 34 current smokers, 249 former smokers, and 359 nonsmokers.”
“Overall, we expected cigarette smokers to have higher rates of complications which was confirmed with our data analysis. We were less confident with our hypothesis that smokers would have worse functional outcome scores. While there is a large body of evidence suggesting tobacco use is associated with higher complication rates, there is little published data regarding the effects of tobacco use on functional outcome scores. In reviewing the literature, we came across studies that reported worse functional outcome scores in smokers after anterior cruciate ligament reconstruction and spine surgery. That being said, our results suggest worse functional outcome scores in cigarette smokers can be expected after total ankle arthroplasty.”
“Our study highlights the importance of preoperative smoking cessation as cigarette smokers have a statistically significant increased risk of wound complications requiring reoperation and less improvement in their patient reported outcomes after total ankle arthroplasty.”
“Our data confirmed our anecdotal experience that active smokers had higher rates of complications after total ankle arthroplasty.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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