Increased Postoperative Complications in Nontobacco Nicotine Users Following Total Hip Arthroplasty

Nicotine use is associated with increased complications after total joint arthroplasty, but data on nontobacco nicotine dependence (NTND), including vaping and smokeless nicotine, are limited. This study evaluated perioperative and postoperative outcomes in NTND patients undergoing total hip arthroplasty (THA).

A retrospective cohort study using a large national database identified primary THA patients (2003 to 2023). Patients were one-to-one propensity-matched into NTND (n = 10,503) and non-nicotine user (n = 10,503) groups. Systemic complications (90 days) and prosthesis-related complications (two years) were assessed.

The NTND patients exhibited significantly higher rates of systemic complications within 90 days, including sepsis (1.0 versus 0.8%, P = 0.047), deep vein thrombosis (1.9 versus 1.4%, P = 0.01), stroke (0.9 versus 0.6%, P = 0.007), and pneumonia (1.8 versus 1.1%, P < 0.001). Opioid use was significantly higher in NTND patients (88.9 versus 81.5%, P < 0.001). The NTND patients had increased readmission (38.4 versus 33.3%, P < 0.001) and emergency department visit rates (12.1 versus 8.3%, P < 0.001). Prosthesis-related complications at two years were also significantly more common in NTND patients, including periprosthetic joint infection (3.0 versus 2.0%, P < 0.001), prosthetic joint dislocation (1.5 versus 1.2%, P = 0.031), and revision THA (4.0 versus 2.8%, P < 0.001).

The NTND patients undergoing THA experience increased medical and surgical complications. As vaping and smokeless nicotine use rise, preoperative screening and cessation strategies should be explored to optimize surgical outcomes.