Smoking Cessation and Relapse Effects on Patient-Reported Outcomes after Total Knee Arthroplasty

Smoking is a risk factor for poor outcomes after total knee arthroplasty (TKA). The purpose of this study was to identify factors that could be modified to increase smoking abstinence and prevent relapse in these patients that would hopefully lead to more satisfactory outcomes. It involved a retrospective analysis of medical records and a survey of 200 patients (100 preoperative smokers and 100 preoperative nonsmokers) who underwent TKA at a single institution between 2018 and 2021. Ages ranged from 28 to 86 years old (mean 65.20). Nonsmokers were slightly older than smokers (67.59 vs. 62.82, respectively). Medical records of the preoperative nonsmokers were reviewed to obtain their postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR) and demographic data. Based on KOOSJR scoring, preoperative nonsmokers had significantly better outcomes compared with preoperative smokers. Nonsmokers had significantly lower overall KOOSJR total scores compared with smokers (P = 0.016). Nonsmokers also demonstrated higher overall knee health than smokers as shown by the KOOSJR converted score and performed better in terms of functional movements. We concluded that nonsmokers have better outcomes than smokers after TKA, as they experienced less pain from movement and better knee health. Smoking-cessation interventions should be implemented both before and after surgery to improve outcomes and prevent smoking relapse.