The Impact of Smoking on Outcomes and Complications in Total Joint Arthroplasty: A Prospective Crossover Study

Study Overview
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Brief Summary
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The purpose of this study is to examine the impact of smoking cessation on total joint arthroplasty patients with respect to perioperative complications and outcomes. The investigators will examine patients who are asked to stop smoking in any manner they choose and also refrain from nicotine replacement therapy, and those who are allowed to continue smoking during the perioperative period for their total knee or total hip replacement.

Official Title
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The Impact of Smoking on Outcomes and Complications in Total Joint Arthroplasty: A Prospective Crossover Study

Conditions
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Smoking, Total Joint Arthroplasty

Intervention / Treatment
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* Diagnostic Test: Blood Draw


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Primary elective total joint arthroplasty patients undergoing surgery with a Rothman Institute arthroplasty surgeon. Participant is a current smoker. Diagnosis of osteoarthritis, inflammatory arthritis, and post-traumatic arthritis. Exclusions criteria: Age < 18 Revision surgery Prior infection in hip or knee at the surgical site BMI >40 (It is currently the standard of care in our practice to require patients to have a BMI < 40 due to an increased risk of infection. This will not represent a change in practice.) Diabetics with Hgb A1C >8 (It is currently the standard of care in our practice to require patients to have a Hgb A1C <8 due to an increased risk of infection. This will not represent a change in practice.) Patients using chewing tobacco, cigars, or other form of oral tobacco product Patients using e-cigarettes or vaporizers

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Smoking Cessation Group<br>participants are required to cease smoking for 4 weeks prior to and 2 weeks after TJA without any nicotine replacement (any other smoking cessation aids the patient chooses will be allowed) | Diagnostic Test: Blood Draw<br>* 2-4 weeks before surgery a blood draw will be taken to test for nicotine levels in the body<br>|
| Smoker Group 2<br>participants who are allowed to continue smoking and using nicotine in any form at their own discretion during the perioperative period | Diagnostic Test: Blood Draw<br>* 2-4 weeks before surgery a blood draw will be taken to test for nicotine levels in the body<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Wound healing | The primary objective of this study is to examine the impact of smoking cessation on total joint arthroplasty patients with respect to combined complications. For the purpose of the study combined complications will include: major in-hospital complications (MI, CVA, PE, pneumonia, return to the operating room, mortality), wound complications, readmission at 90 days, 90-day major complications (MI, CVA, PE, pneumonia, return to the operating room, mortality), and wound complications (prolonged hospitalization due to a wound issue, prolonged drainage > 7 days, superficial or deep SSI | 3 months |