• Jourdan Cancienne, Kyle N Kunze, Edward C Beck, Jorge Chahla, Sunikom Suppauksorn, and Shane J Nho.
• Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
• Am J Sports Med. 2019 Apr 1; 47 (5): 1138-1144.

BackgroundThere is literature on the association between smoking in patients undergoing orthopaedic procedures and poor short-term outcomes. However, there are few data on smoking as an independent predictor of midterm outcomes in patients undergoing hip arthroscopic surgery for femoroacetabular impingement (FAI).PurposeTo evaluate 2-year postoperative outcomes in patients undergoing hip arthroscopic surgery for FAI in current smokers compared with an age- and body mass index (BMI)-matched group with no smoking history.Study DesignCohort study; Level of evidence, 3.MethodsConsecutive patients undergoing primary hip arthroscopic surgery for FAI between June 2012 and January 2016 were screened for smoking habits. Exclusion criteria included revision or bilateral surgery, dysplasia, and less than 2-year follow-up. Forty current smokers at the time of surgery were matched 1:2 by age and BMI to patients with no smoking history. Outcome measures included the Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sports-Specific Subscale (SSS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction. Minimal clinically important difference (MCID) and patient acceptable symptom state rates were calculated for all patients.ResultsAll patients demonstrated significant improvements in all outcome measures ( P < .001). Current smokers experienced inferior postoperative HOS-ADL (80.4 vs 89.1, respectively; P = .013) and HOS-SSS (65.8 vs 75.6, respectively; P = .046) scores and greater VAS pain scores (3.2 vs 1.8, respectively; P = .011) than nonsmokers. Current smoking was correlated with inferior HOS-ADL ( r = -0.27, P = .003) and HOS-SSS ( r = -0.18, P = .046) scores and greater VAS pain scores ( r = 0.26, P = .005). Controlling for age, sex, and BMI, smoking was a significant independent predictor of postoperative HOS-ADL (β = -8.7 [95% CI, -14.3 to -3.0]; P = .003), HOS-SSS (β = -9.8 [95% CI, -19.5 to -0.2]; P = .046), and VAS pain (β = 14.6 [95% CI, 4.4 to 23.7]; P = .005) scores. Current smokers had lower odds of achieving the MCID for the HOS-ADL (odds ratio, 0.31 [95% CI, 0.12-0.83]; P = .019) and mHHS (odds ratio, 0.31 [95% CI, 0.10-0.88]; P = .028).ConclusionCurrent smokers had inferior postoperative HOS-ADL and HOS-SSS scores, increased pain, and lower odds of achieving the MCID for the HOS-ADL and mHHS at 2 years postoperatively than patients without any smoking history.

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