, Volume 471, Issue 2, pp 486-497
Date: 05 Jan 2013

Smoking May Be a Harbinger of Early Failure With Ultraporous Metal Acetabular Reconstruction

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Abstract

Background

Smoking is considered a risk factor for surgical complications in total hip arthroplasty (THA) and has been linked to a higher rate of aseptic loosening in uncemented acetabular components. Acetabular reconstruction with newer ultraporous metals in both complex primary and revision THA has increased survivorship but it is unclear whether smoking affects survival of these implants.

Questions/purposes

We reviewed our early experience with THA using ultraporous acetabular components to assess the incidence and etiology of early failure and examine if any preoperative variables, including smoking, related to failure.

Methods

We used ultraporous acetabular components in 498 patients (534 hips), beginning with one case each in 1999 and 2004, 17 in 2005, and the majority from 2006 through March 2010. There were 159 complex primary and 375 revision cases. Of these patients, 17% were smokers (averaging 35 pack-years), 31% previous smokers (averaging 29 pack-years), 41% nonsmokers, and 1% unknown. Failure modes possibly related to smoking were infection, aseptic loosening, or periacetabular fracture and unrelated were dislocation and implant breakage. Minimum followup was 1 month (average, 32 months; range, 1–78 months).

Results

There were 34 cup failures (6%): 17 infections, 14 aseptic loosening, and one each liner breakage, dislocation, and periacetabular fracture. The failure rate (uncontrolled for potentially confounding variables) was 10% in both current (9 of 89) and prior smokers (17 of 167) and 3% in nonsmokers 8 of 271).

Conclusion

With ultraporous metal technology in complex primary and revision THA, smoking, both past and current, may be a risk factor for early failure.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

One of the authors (AVL) certifies that he has or may receive payments or benefits, in any one year, an amount in excess of USD 1,000,000, from Biomet, Inc (Warsaw, IN, USA) and Innomed, Inc (Savannah, GA, USA). One of the authors (KRB) certifies that he has or may receive payments or benefits, in any one year, an amount in excess of USD 1,000,000, from Biomet, Inc. The institution of the authors has received institutional research support from Biomet, Stryker (Mahwah, NJ, USA), and a grant from the Piedmont Orthopaedic Society (Durham, NC, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at Joint Implant Surgeons, Inc, New Albany, OH, USA.