Tobacco Use Is a Risk Factor for Prosthetic Joint Infection After Total Hip Arthroplasty

Sarfaroj Khan 


January 06, 2021


  • Tobacco use was associated with an increased risk of developing prosthetic joint infections (PJIs), particularly deep infection or infection requiring revision surgery in patients undergoing total hip arthroplasty (THA).

Why this matters

  • Findings reflect the recommendation of tobacco use cessation before THA.

  • Additional preventive measurements are advisable when tobacco users undergo THA to reduce the likelihood of PJIs.

Study design

  • Meta-analysis of 10 case-control studies including 20,640 patients undergoing THA (5328, tobacco users; 15,312 nonusers).

  • Funding: None.

Key results

  • The pooled OR of developing a superficial infection, a deep infection, or an infection requiring revision surgery for tobacco users vs non-users was 1.54 (95% CI, 1.25-1.91; P<.0001) when a fixed-effect model was used and 1.56 (95% CI, 1.10-2.21; P=.0005) when a random-effect model was used.

  • When individual outcomes were considered, tobacco use was associated with an increased of:

    • deep infections (7 studies; pooled OR, 1.81; 95% CI, 1.39-2.36); and

    • infection requiring revision surgery (5 studies; pooled OR, 2.02; 95% CI, 1.16-3.51).

  • Tobacco use was not significantly associated with superficial infections after THA (4 studies; pooled OR, 0.89; 95% CI, 0.58-1.37).


  • Heterogeneity among studies.


Bojan B, Perni S, Prokopovich P. Systematic Review and Meta-Analysis of Tobacco Use as a Risk Factor for Prosthetic Joint Infection After Total Hip Replacement. Arthroplast Today. 2020;6(4):959-971. doi: 10.1016/j.artd.2020.07.011. PMID: 33385034 View abstract  

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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