Blog - Smoking and Joint Replacement

Smoking and Joint Replacement


“Doctor, I’m a chain smoker and I am planning for my knee replacement surgery. Should I continue smoking and have my surgery?”

Joint replacement surgeons often hear this question in their offices. Quitting smoking is one of the most critical things to do in preparation for hip or knee replacement surgery for it to be successful. It is well known that the effects of nicotine on the body directly cause chronic obstructive pulmonary disease, lung cancer, vascular disease, hypertension, coronary artery disease, and blood clots – just to name a few. It is important to know that smoking and using nicotine products can negatively impact upcoming hip or knee replacement surgery and how well you do after surgery.

How Nicotine Impacts Healing

Toxins in cigarette smoke affect the body’s inflammatory response which in turn affects the body’s ability to heal. This can lead to weak scar tissue and an increased risk of problems with the wound. Studies have shown that active cigarette smokers have up to 1.5 to 3.2 times increased risk of wound-related complications following joint replacement surgery. The carbon monoxide and nicotine gas in tobacco smoke reduce the ability of blood to carry oxygen to tissues effectively.

The toxins in cigarette smoke also alter the body’s immune system by slowing the white blood cells’ ability to respond to infections. Ultimately, the poor scar formation, wound problems, poor oxygen delivery, and poor immune response from smoking have the combined effect of greatly increasing your risk of developing a prosthetic joint infection by up to 1.8 times. Infection after joint replacement surgery can be a devastating complication, and every effort should be made to prevent these complications.

Healing and Pain issues with smokers

Many published articles have shown that active smokers take longer to recover and stay longer in the hospital following hip and knee replacement surgeries. In addition, smokers have increased rates of being readmitted to the hospital for complications after surgery. Tobacco smokers have been found to have poor pain control after joint replacement surgery and compared to nonsmokers, they require significantly greater doses of narcotic pain medications like opioids. Smoking distorts a patient’s immune system and can delay healing, increasing the risk of infection at the wound site. Smoking just one cigarette decreases the body’s ability to deliver necessary nutrients for healing after surgery.

Quitting is Essential

Although smoking can have these devastating complications, the good news is that quitting smoking and avoiding nicotine products can improve your chances of having a successful surgery. If you quit smoking for four to six weeks prior to surgery and continue for four weeks after, studies show that you can reduce your risk of complications by up to 50%. The longer you stay away from smoking and nicotine, the greater the benefit.

Still, research has shown that regardless of current smoking status, the amount that one smoked over his or her lifetime significantly contributed to the increased risk of complication. This risk increased depending on how many packs had been smoked per decade.


Smokers Show an 80 Percent Increase in Risk of Reoperations for Infection, so a smoking cessation program is essential before Joint Replacement surgery. The good news is that an upcoming surgery can be just the motivation a smoker needs to finally kick the habit. Quitting tobacco is always a good idea, and your upcoming surgery can be a game-changer.

For more details and appointments, you may consult our expert surgeon, Dr. Manuj Wadhwa. To schedule an online appointment, please click here..In case of emergency, visit us.

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