• Moritz Starzer, Maria Anna Smolle, Ines Vielgut, Georg Hauer, Lukas Leitner, Roman Radl, Reinhard Ehall, Andreas Leithner, and Patrick Sadoghi.
• Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria.
• Arch Orthop Trauma Surg. 2023 Aug 1; 143 (8): 468946954689-4695.

IntroductionSmoking has been associated with numerous adverse outcomes following surgical procedures. The purpose of this study was to investigate, whether smoking status at time of surgery influences the outcome of primary TKA.Materials And MethodsSix hundred and eighty-one patients who underwent primary TKA between 2003 and 2006 were included in the study. Smoking status was defined as current, former, and never smoker. Complications leading to revisions were assessed until 17 years of follow-up. Functional outcome was evaluated using clinical scores: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, Short Form-12 Physical and Mental Component Summaries (SF-12PCS/MCS), and Knee Society Function and Knee Score (KSFS and KSKS).ResultsAt a mean follow-up of 95 months (± 47 months), 124 complications led to revision surgery. Soft-tissue complications (OR, 2.35 [95% CI 1.08-5.11]; p = 0.032), hematoma formation (OR, 5.37 [95% CI 1.01-28.49]; p = 0.048), and restricted movement (OR, 3.51 [95% CI 1.25-9.84]; p = 0.017) were more likely to occur in current smokers than never smokers. Current smokers were more likely to score higher at KSFS (p < 0.001) and SF-12PCS (p = 0.0197) compared to never smokers. For overall revision, differences were noted.ConclusionCurrent smoking increases risk of soft-tissue complications and revision after primary TKA, especially due to hematoma and restricted movement. Smoking cessation programs could reduce the risk of revision surgery.© 2023. The Author(s).

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