The most important factor associated with an increased risk of revision following total knee arthroplasty (TKA) is smoking, according to Pam Harrison, writing for MedPage Today. Though being a male was also associated with a higher risk of revision, older age was not. Benedict Nwachukwu, M.D, of the Hospital for Special Surgery in New York City, and colleagues conducted the study and found a nearly threefold increased risk for revision among smokers.
Their study involved 436 patients who had had a TKA over a 13 year period, 146 who had had both a primary and a revision TKA and 290 patients who had a primary TKA and no revision. The only technical factor that increased the risk of revision, wrote the researchers, was the receipt of a lateral release, which increased revision risk by 92%. They explained that lateral release during a TKA is a surgical technique whereby tight lateral soft tissue structures of the knee are released.
In their search for the problems caused by smoking, the researchers found that cigarette smoke disrupts osteointegration, a fundamental process in the longevity of implanted materials. In addition, they said that nicotine inhibits secretion of tumor necrosis factor-alpha, a critical cytokine for bone remodeling.
The researchers noted that “Given the procedural complexity of revision procedures, growth in utilization of revision TKAs will further strain healthcare resources.”
