Cigarette smoking and nonunion after ankle arthrodesis

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Health
• Smoking Cessation

Background:

• Ankle arthrodesis is a surgical procedure to fuse the ankle joint, often performed for severe arthritis or deformity.
• Nonunion, the failure of the bones to fuse, is a significant complication following ankle arthrodesis.
• Smoking is a known risk factor for impaired bone healing, but its specific impact on ankle arthrodesis nonunion requires further elucidation.

Purpose of the Study:

• To determine the relative risk of nonunion in smokers compared to nonsmokers after ankle arthrodesis.
• To quantify the increased risk of nonunion associated with active smoking and smoking history in this patient population.

Main Methods:

• A case-control study design was employed.
• Twenty-two patients who experienced nonunion after ankle arthrodesis (cases) were matched with 22 patients who achieved union (controls).
• Matching criteria included age, sex, surgeon, surgical technique, and preoperative diagnosis. Smoking status, duration, amount, and history were collected for all participants.

Main Results:

• Ten cases were active smokers at the time of surgery, compared to four controls.
• The relative risk of nonunion was 3.75 times higher for active smokers.
• In patients without other known risk factors for nonunion, active smokers had a 16-fold increased risk of nonunion compared to nonsmokers.

Conclusions:

• Active smoking is a significant independent risk factor for nonunion following ankle arthrodesis.
• Patients undergoing ankle arthrodesis should be strongly advised to cease smoking to improve surgical outcomes.
• Further research could explore interventions to mitigate smoking-related risks in orthopedic surgery.