TY  - JOUR
A1  - Ehnert, Sabrina
A1  - Aspera-Werz, Romina Haydeé
A1  - Ihle, Christoph
A1  - Trost, Markus
A1  - Zirn, Barbara
A1  - Flesch, Ingo
A1  - Schröter, Steffen
A1  - Relja, Borna
A1  - Nussler, Andreas Klaus
T1  - Smoking dependent alterations in bone formation and inflammation represent major risk factors for complications following total joint arthroplasty
T2  - Journal of Clinical Medicine
N2  - Numerous studies have described a correlation between smoking and reduced bone mass. This not only increases fracture risk but also impedes reconstruction/fixation of bone. An increased frequency of complications following surgery is common. Here, we investigate the effect of smoking on the clinical outcome following total joint arthroplasty (TJA). 817 patients receiving primary or revision (including clinical transfers) TJA at our level-one trauma center have been randomly interviewed twice (pre- and six months post-surgery). We found that 159 patients developed complications (infections, disturbed healing, revisions, thrombosis, and/or death). Considering nutritional status, alcohol and cigarette consumption as possible risk factors, OR was highest for smoking. Notably, mean age was significantly lower in smokers (59.2 ± 1.0a) than non-smokers (64.6 ± 0.8; p < 0.001). However, the number of comorbidities was comparable between both groups. Compared to non-smokers (17.8 ± 1.9%), the complication rate increases with increasing cigarette consumption (1–20 pack-years (PY): 19.2 ± 2.4% and >20 PY: 30.4 ± 3.6%; p = 0.002). Consequently, mean hospital stay was longer in heavy smokers (18.4 ± 1.0 day) than non-smokers (15.3 ± 0.5 day; p = 0.009) or moderate smokers (15.9 ± 0.6 day). In line with delayed healing, bone formation markers (BAP and CICP) were significantly lower in smokers than non-smokers 2 days following TJA. Although, smoking increased serum levels of MCP-1, OPG, sRANKL, and Osteopontin as well as bone resorption markers (TRAP5b and CTX-I) were unaffected. In line with an increased infection rate, smoking reduced 25OH vitamin D3 (immune-modulatory), IL-1β, IL-6, TNF-α, and IFN-γ serum levels. Our data clearly show that smoking not only affects bone formation after TJA but also suppresses the inflammatory response in these patients. Thus, it is feasible that therapies favoring bone formation and immune responses help improve the clinical outcome in smokers following TJA.
KW  - total joint arthroplasty (TJA)
KW  - cigarettes
KW  - smoking
KW  - pack-years (PY)
KW  - complications
KW  - infection
KW  - delayed wound healing
KW  - revision surgery
KW  - bone metabolism
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/50359
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-503591
SN  - 2077-0383
N1  - This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
VL  - 8
IS  - 3, Art. 406
SP  - 1
EP  - 16
PB  - MDPI
CY  - Basel
ER  -