Smoking a risk factor for early failure in primary, revision THA April 13, 2012 Researchers found smoking to be a significant risk factor for early failure in complex primary and revision total hip arthroplasties, even with the use of ultraporous acetabular components. Adolph V. Lombardi, Jr., MD, presented his team’s findings at the American Academy of Orthopaedic Surgeons Annual Meeting in San Francisco. Lombardi and his team looked at 10 years’ worth of hip procedures, identifying ultraporous acetabular component use in 535 hips in 500 patients. There were 160 complex primary and 375 revision cases in the cohort, according to the study abstract. “As far as the patients’ history of smoking: 50% never smoked, 3% we were unable to determine, 17% were current smokers and 30% had prior smoking history,” Lombardi said. The results of the study, Lombardi noted, indicate smoking is a significant risk factor in early failure. “This is the nuts and bolts - reasons for failure,” he said. “Infection, aseptic loosening and periacetabular failure - all of which we believe may be affected by smoking. As we looked at overall failure by smoking history, it was statistically significantly higher in our current and prior smokers vs. our never smokers.” According to the abstract, there were 33 failures at an average of 18 postoperative months. Lombardi noted a failure rate in smokers of 11%, with a failure rate of 3.8% in non-smokers and 5.3% in previous smokers. “Our take-home message is that even with ultraporous technology, smoking seems to be a significant risk factor for early failure,” Lombardi said. “I think we should encourage our patients to quit smoking. It will reduce the risk, but not totally, and smoking cessation should be considered part of your preoperative education program.” Reference: Lombardi AV, Berend KR, Morris MJ, et al. Smoking is a harbinger of early failure with ultraporous metal acetabular reconstruction. Paper #223. Presented at the American Academy of Orthopaedic Surgeons Annual Meeting. Feb. 7-11, 2012. San Francisco.