Presentation Abstract

Session: 15-Adult Reconstruction Hip II
Date/Time: Wednesday, Feb 08, 2012, 12:06 PM -12:12 PM
Presentation Number: 223
Title: Smoking is a Harbinger of Early Failure with Ultraporous Metal Acetabular Reconstruction
Classification: Adult Reconstruction Hip
Keywords: Revision / Acetabular Component; Primary Total Hip Arthroplasty Cementless; Miscellaneous; Complications; Total Hip Arthroplasty
Author(s): Adolph V. Lombardi, Jr, MD, New Albany, Ohio, United States
Keith R. Berend, MD, New Albany, Ohio, United States
Michael J. Morris, MD, New Albany, Ohio, United States
Joanne B. Adams, BFA, CMI, New Albany, Ohio, United States
Michael A. Sneller, BS, New Albany, Ohio, United States
Tawnya Tucker, MT, New Albany, Ohio, United States
Acetabular reconstruction with newer ultraporous metal in both complex primary and revision total hip arthroplasty (THA) has increased survivorship with stable fixation and few failures. Smoking is considered a risk factor for surgical complications including transfusion, infection and cardiac. We hypothesized that the early results of ultraporous metal acetabular reconstruction would be unaffected by smoking in complex primary and revision THA.
Between 1999 and 2009, ultraporous acetabular components were used in 535 hips (500 patients) for 160 complex primary and 375 revision cases. Of these patients 17% were smokers, 29.5% previous smokers, 49.0% non-smokers and 4.5% unknown. Early failures possibly related to negative effects of smoking were considered any infection, failure of in-growth or periacetabular fracture. Failures not considered related to smoking included dislocation and implant breakage.
There were 33 failures at an average of 18 months post-operative for a failure rate of 6.2%: 15 infections, 13 failure of ingrowth, three dislocations, and one each liner fracture and periacetabular fracture. The failure rate in smokers was 11%, in non-smokers 3.8%, and in previous smokers 5.3% (Pearson’s 6.5; p=0.01). With only smoking related failures included, the rate was 9% in smokers and 3.6% in non-smokers (4.6; p=0.03). With previous smokers included as smokers failure is 9.2% (6.2; p=0.01) and included as non-smokers 5.8% (3.7; p=0.05).
Even with ultraporous metal technology, smoking is a significant risk factor for early failure in complex primary and revision THA. Quitting smoking reduces the inherent risk. Smoking cessation should be considered during pre-operative education.

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