Effect of smoking on hip arthroscopy outcomes: a systematic review and meta-analysis
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20244051Keywords:
mHHS, Sports-specific hip function, Meta-analysis, Patient satisfaction, Hip arthroscopy, Smoking, Functional outcomesAbstract
Hip arthroscopy is an increasingly utilized procedure for treating various hip pathologies. However, patient-related factors, such as smoking, may significantly impact postoperative outcomes. Smoking is known to impair tissue healing and increase the risk of complications, potentially leading to poorer surgical results. This meta-analysis aims to evaluate the effect of smoking on outcomes following hip arthroscopy, focusing on functional scores, pain levels, and patient satisfaction. A comprehensive search was conducted in PubMed, Web of Science, Scopus, Medline, the Cochrane Library, and Google Scholar to identify studies assessing hip arthroscopy outcomes in smokers and nonsmokers. After removing duplicates, screening titles and abstracts, and assessing full-text eligibility, five studies were included in the quantitative synthesis. Outcomes were pooled using a fixed-effect model to calculate mean differences and 95% confidence intervals (CIs). The meta-analysis included data from five studies with a total of 618 patients (234 smokers and 384 nonsmokers). The hip outcome score–sports specific (HOS-SS) was significantly lower in smokers, with a mean difference of -8.63 (95% CI: -12.71, -4.54), indicating worse sports-specific function. The modified Harris hip score (mHHS) was also significantly lower in smokers (mean difference: -4.47, 95% CI: -7.50, -1.44). Pain levels measured by the visual analog scale (VAS) were higher in smokers (mean difference: 0.62, 95% CI: 0.17, 1.06). However, there was no significant difference in satisfaction VAS scores between smokers and nonsmokers (mean difference: -0.13, 95% CI: -0.61, 0.34). In conclusion, smoking is associated with significantly worse functional outcomes and higher pain levels following hip arthroscopy. These findings highlight the importance of smoking cessation programs for patients undergoing hip arthroscopy to improve surgical outcomes. Despite the worse functional and pain outcomes, patient satisfaction did not differ significantly, which may indicate a disparity between objective outcomes and subjective satisfaction in smokers.
Metrics
References
Griffin DR, Dickenson EJ, Wall PD, Achana F, Donovan JL, Griffin J, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. The Lancet. 2018;391(10136):2225-35.
Zaltz I, Kelly BT, Larson CM, Leunig M, Bedi A. Surgical treatment of femoroacetabular impingement: what are the limits of hip arthroscopy? Arthroscopy J Arthroscopic Rel Surg. 2014;30(1):99-110.
Nossa JM, Aguilera B, Márquez W, Aranzazu A, Alzate R, Rueda G, et al. Factors associated with hip arthroscopy complications in the treatment of femoroacetabular impingement. Curr Orthop Pract. 2014;25(4):362-6.
Singh JA. Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol. 2011;38(9):1824-34.
Matharu GS, Mouchti S, Twigg S, Delmestri A, Murray DW, Judge A, et al. The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients. Acta Orthopaed. 2019;90(6):559-67.
Schmid M, Sood A, Campbell L, Kapoor V, Dalela D, Klett DE, et al. Impact of smoking on perioperative outcomes after major surgery. Am J Surg. 2015;210(2):221-9.
Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR. The effect of cigarette smoking and smoking cessation on spinal fusion. Spine. 2000;25(20):2608-15.
Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Verheyen CC. Minimally invasive versus classic procedures in total hip arthroplasty: a double-blind randomized controlled trial. Clin Orthopaed Rel Res. 2011;469:200-8.
Kuroda Y, Saito M, Çınar EN, Norrish A, Khanduja V. Patient-related risk factors associated with less favourable outcomes following hip arthroscopy: A scoping review. Bone Joint J. 2020;102(7):822-31.
Agrawal S, Ingrande J, Said ET, Gabriel RA. The association of preoperative smoking with postoperative outcomes in patients undergoing total hip arthroplasty. J Arthropl. 2021;36(3):1029-34.
Duchman KR, Gao Y, Pugely AJ, Martin CT, Noiseux NO, Callaghan JJ. The effect of smoking on short-term complications following total hip and knee arthroplasty. JBJS. 2015;97(13):1049-58.
Teng S, Yi C, Krettek C, Jagodzinski M. Smoking and risk of prosthesis-related complications after total hip arthroplasty: a meta-analysis of cohort studies. PloS one. 2015;10(4):e0125294.
Burn E, Edwards CJ, Murray DW, Silman A, Cooper C, Arden NK, et al. The impact of BMI and smoking on risk of revision following knee and hip replacement surgery: evidence from routinely collected data. Osteoarthr Cartilage. 2019;27(9):1294-300.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Peterson J, Welch V, Losos M, Tugwell PJ. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Res Instit. 2011;2(1):1-2.
Cancienne J, Kunze KN, Beck EC, Chahla J, Suppauksorn S, Nho SJ. Influence of cigarette smoking at the time of surgery on postoperative outcomes in patients with femoroacetabular impingement: a matched-pair cohort analysis. Am J Sports Med. 2019;47(5):1138-44.
Jimenez AE, Lee MS, George T, Owens JS, Maldonado DR, Saks BR, et al. Effect of Cigarette Smoking on Outcomes in Patients Undergoing Primary Hip Arthroscopy and Labral Reconstruction: A Propensity-Matched Controlled Study with Minimum 2-Year Follow-up. Orthop J Sports Med. 2022;10(2):23259671221075642.
Jimenez AE, Lee MS, Owens JS, Maldonado DR, Saks BR, Lall AC, et al. Effect of Cigarette Smoking on Midterm Outcomes After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome: A Propensity-Matched Controlled Study with Minimum 5-Year Follow-up. Orthopaed J Sports Med. 2022;10(5):23259671221090905.
Lall AC, Hammarstedt JE, Gupta AG, Laseter JR, Mohr MR, Perets I, et al. Effect of cigarette smoking on patient-reported outcomes in hip arthroscopic surgery: a matched-pair controlled study with a minimum 2-year follow-up. Orthopaed J Sports Med. 2019;7(1):2325967118822837.
Lee MS, Jimenez AE, Owens JS, Curley AJ, Paraschos OA, Maldonado DR, et al. Comparison of outcomes between nonsmokers and patients who discontinued smoking 1 month before primary hip arthroscopy: a propensity-matched study with minimum 2-year follow-up. Orthop J Sports Med. 2022;10(6):23259671221097372.
Niu S, Lim F. CE: The effects of smoking on bone health and healing. Am J Nurs. 2020;120(7):40-5.
Patel RA, Wilson RF, Patel PA, Palmer RM. The effect of smoking on bone healing: a systematic review. Bone Joint Res. 2013;2(6):102-11.
D'Anna C, Cigna D, Costanzo G, Ferraro M, Siena L, Vitulo P, et al. Cigarette smoke alters cell cycle and induces inflammation in lung fibroblasts. Life Sci. 2015;126:10-8.
Wong LS, Martins‐Green M. Firsthand cigarette smoke alters fibroblast migration and survival: implications for impaired healing. Wound Repair Regeneration. 2004;12(4):471-84.
Cusano NE. Skeletal effects of smoking. Curr Osteop Rep. 2015;13:302-9.
Sørensen LT, Toft B, Rygaard J, Ladelund S, Teisner B, Gottrup F. Smoking attenuates wound inflammation and proliferation while smoking cessation restores inflammation but not proliferation. Wound Repair Regenerat. 2010;18(2):186-92.
Downloads
Published
How to Cite
Issue
Section
