Tobacco use may yield severe adverse outcomes vs morbid obesity after aseptic revision TKA
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Published results showed no association between morbid obesity and an increased risk in adverse outcomes after aseptic revision total knee arthroplasty, but an association between tobacco use and severe complications.
James A. Keeney, MD, and colleagues compared demographic characteristics, surgical indications and adverse outcomes for 270 index aseptic revision TKAs performed for patients with morbid obesity (n=73), diabetes (n=72) or tobacco use (n=125) and 239 “healthy” patients without these risk factors.
“We performed the study to see if there were differences in complication risks among patients who only had a single potentially modifiable risk factor alone (morbid obesity, diabetes or smoking history),” Keeney told Healio. “We expected that the most frequent and most severe complications would occur among morbidly obese patients after revision TKA, but this is not what our study data ended up telling us. Instead of extreme overweight status, a history of tobacco use was more likely to result in additional surgery and the most severe complications.”
Results showed the 2-year reoperation rate and component revision rate did not differ between patients who were morbidly obese and patients who were healthy. In contrast, researchers noted patients with diabetes were more likely to have additional surgery, early reoperation within 90 days and surgery within 2 years. Patients with diabetes also had a trend toward higher extensor mechanism failure rates, according to results.
Researchers found patients with tobacco use had higher rates of reoperation, surgery within 2 years, early reoperation for a hematoma, revision for infection and above knee amputation compared with patients who were healthy. Multivariate analysis showed an independent association between smoking history and amputation risk.
“The study cannot answer whether smoking cessation will eliminate these risks, but we consider efforts to stop smoking for at least 4 weeks ahead and after revision TKA to be a reasonable recommendation, just as this is a common recommendation for patients undergoing elective first-time joint replacement — especially for cases where a delay in revision surgery is not expected to complicate outcomes on its own,” Keeney said.
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