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The Journal of Hip Surgery 2020; 4(04): 166-172
DOI: 10.1055/s-0040-1721119
Original Article

Are Elevated Nicotine and Cotinine Levels Associated with Early Femoral Component Subsidence in Press-Fit, Primary Total Hip Arthroplasty?

Brian T. Muffly
1   Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
,
Cale A. Jacobs
1   Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
,
Stephen T. Duncan
1   Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
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Abstract

Tobacco exposure negatively affects bone mineral density and early osseointegration of surgical implants. We sought to determine if elevated nicotine and/or cotinine levels prior to primary total hip arthroplasty (THA) are associated with early femoral component subsidence. We hypothesize that tobacco users will have higher rates of readmission/reoperation and increased radiographic subsidence. We conducted an institutional review of 75 patients (average age = 52.9 years; 55% females; body mass index = 31.3) who underwent THA from April 2017 to January 2018. Immediate postoperative radiographs were compared with those obtained at 2 to 6 weeks postoperatively to determine early femoral component subsidence. Of the 75 patients, 10 (13.3%) had early radiographic femoral component subsidence ≥ 2 mm. In this group, preoperative nicotine levels were significantly elevated (7.2 vs. 1.5ng/mL; p = 0.04), whereas preoperative cotinine levels did not statistically differ (108.3 vs. 33.8 ng/mL; p = 0.45). A significantly greater magnitude of subsidence was seen in those with elevated preoperative nicotine levels compared with those with normal levels (1.7 vs. 0.5 mm; p = 0.04). The mean time to radiographic follow-up was 2.6 weeks. Surgical approach, implant type, categorical variables, and patient readmission were not associated with ≥ 2 mm of early subsidence. There was a single reoperation for periprosthetic fracture, but none was related to instability from subsidence. Early femoral component subsidence was more prevalent in patients with elevated preoperative nicotine levels. Rates of readmission/reoperation at 90 days did not differ between those with and without elevated tobacco markers. Clinically relevant thresholds of preoperative nicotine and/or cotinine values are needed to better delineate appropriate surgical candidates to achieve optimal surgical outcomes.

Keywords

early femoral component subsidence - tobacco - primary total hip arthroplasty - nicotine - cotinine


Publication History

Received: 29 March 2020

Accepted: 27 July 2020

Article published online:
23 November 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007; 370 (9597): 1508-1519
    CrossrefPubMedGoogle Scholar
  • 2 Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 2019; 393 (10172): 647-654
    CrossrefPubMedGoogle Scholar
  • 3 Troelsen A, Malchau E, Sillesen N, Malchau H. A review of current fixation use and registry outcomes in total hip arthroplasty: the uncemented paradox. Clin Orthop Relat Res 2013; 471 (07) 2052-2059
    CrossrefPubMedGoogle Scholar
  • 4 Bunyoz KI, Malchau E, Malchau H, Troelsen A. Has the use of fixation techniques in THA changed in this decade? The uncemented paradox revisited. Clin Orthop Relat Res 2020; 478 (04) 697-704
    CrossrefPubMedGoogle Scholar
  • 5 White CA, Carsen S, Rasuli K, Feibel RJ, Kim PR, Beaulé PE. High incidence of migration with poor initial fixation of the Accolade stem. Clin Orthop Relat Res 2012; 470 (02) 410-417
    CrossrefPubMedGoogle Scholar
  • 6 Parvizi J, Keisu KS, Hozack WJ, Sharkey PF, Rothman RH. Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem. J Arthroplasty 2004; 19 (02) 151-156
    CrossrefPubMedGoogle Scholar
  • 7 McLaughlin JR, Lee KR. Uncemented total hip arthroplasty using a tapered femoral component in obese patients: an 18-27 year follow-up study. J Arthroplasty 2014; 29 (07) 1365-1368
    CrossrefPubMedGoogle Scholar
  • 8 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    Google Scholar
  • 9 Stryker LS. Modifying risk factors: strategies that work diabetes mellitus. J Arthroplasty 2016; 31 (08) 1625-1627
    CrossrefPubMedGoogle Scholar
  • 10 Springer BD. Modifying risk factors for total joint arthroplasty: strategies that work nicotine. J Arthroplasty 2016; 31 (08) 1628-1630
    CrossrefPubMedGoogle Scholar
  • 11 Fournier MN, Hallock J, Mihalko WM. Preoperative optimization of total joint arthroplasty surgical risk: obesity. J Arthroplasty 2016; 31 (08) 1620-1624
    CrossrefPubMedGoogle Scholar
  • 12 Singh JA, Houston TK, Ponce BA. et al. Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans. Arthritis Care Res (Hoboken) 2011; 63 (10) 1365-1374
    CrossrefPubMedGoogle Scholar
  • 13 Lee S, Yoon DH, Kim KN, Shin DA, Ha Y. Association between urine cotinine levels and bone mineral density in lumbar spine and femoral neck among adult males. Spine 2014; 39 (04) 311-317
    CrossrefPubMedGoogle Scholar
  • 14 Fleischman AN, Chen AF. Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls. Ann Transl Med 2015; 3 (16) 234
    PubMedGoogle Scholar
  • 15 Grant TW, Lovro LR, Licini DJ, Warth LC, Ziemba-Davis M, Meneghini RM. Cementless tapered wedge femoral stems decrease subsidence in obese patients compared to traditional fit-and-fill stems. J Arthroplasty 2017; 32 (03) 891-897
    CrossrefPubMedGoogle Scholar
  • 16 Rao RR, Sharkey PF, Hozack WJ, Eng K, Rothman RH. Immediate weightbearing after uncemented total hip arthroplasty. Clin Orthop Relat Res 1998; (349) 156-162
    CrossrefPubMedGoogle Scholar
  • 17 Teloken MA, Bissett G, Hozack WJ, Sharkey PF, Rothman RH. Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (tri-lock) inserted without cement. J Bone Joint Surg Am 2002; 84 (12) 2140-2144
    CrossrefPubMedGoogle Scholar
  • 18 Walker PS, Mai SF, Cobb AG, Bentley G, Hua J. Prediction of clinical outcome of THR from migration measurements on standard radiographs. A study of cemented Charnley and Stanmore femoral stems. J Bone Joint Surg Br 1995; 77 (05) 705-714
    CrossrefPubMedGoogle Scholar
  • 19 Bottner F, Pellicci PM. Review: posterior soft tissue repair in primary total hip arthroplasty. HSS J 2006; 2 (01) 7-11
    CrossrefPubMedGoogle Scholar
  • 20 Jacobs CA, Christensen CP. Progressive subsidence of a tapered, proximally coated femoral stem in total hip arthroplasty. Int Orthop 2009; 33 (04) 917-922
    CrossrefPubMedGoogle Scholar
  • 21 Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone 1993; 14 (03) 231-242
    CrossrefPubMedGoogle Scholar
  • 22 Parry JA, Hernandez NM, Berry DJ, Abdel MP, Yuan BJ. Risk factors for subsidence of modular fluted tapered stems used during revision total hip arthroplasty for periprosthetic hip fractures. J Arthroplasty 2018; 33 (09) 2967-2970
    CrossrefPubMedGoogle Scholar
  • 23 Song JH, Jo WL, Lee KH, Cho YJ, Park J, Oh S. Subsidence and perioperative periprosthetic fractures using collarless hydroxyapatite-coated stem for displaced femoral neck fractures according to Dorr type. J Orthop Surg (Hong Kong) 2019; 27 (03) 2309499019877530
    CrossrefPubMedGoogle Scholar
  • 24 Patel RA, Wilson RF, Patel PA, Palmer RM. The effect of smoking on bone healing: A systematic review. Bone Joint Res 2013; 2 (06) 102-111
    CrossrefPubMedGoogle Scholar
  • 25 Zhang J, Wan Q, Yu X, Cheng G, Ni Y, Li Z. Low-dose nicotine reduces the homing ability of murine BMSCs during fracture healing. Am J Transl Res 2018; 10 (09) 2796-2809
    PubMedGoogle Scholar
  • 26 Santiago HA, Zamarioli A, Sousa Neto MD, Volpon JB. Exposure to secondhand smoke impairs fracture healing in rats. Clin Orthop Relat Res 2017; 475 (03) 894-902
    CrossrefPubMedGoogle Scholar
  • 27 Berley J, Yamano S, Sukotjo C. The effect of systemic nicotine on osseointegration of titanium implants in the rat femur. J Oral Implantol 2010; 36 (03) 185-193
    CrossrefPubMedGoogle Scholar
  • 28 Bezerra Ferreira JD, Rodrigues JA, Piattelli A, Iezzi G, Gehrke SA, Shibli JA. The effect of cigarette smoking on early osseointegration of dental implants: a prospective controlled study. Clin Oral Implants Res 2016; 27 (09) 1123-1128
    CrossrefPubMedGoogle Scholar
  • 29 Ehnert S, Aspera-Werz RH, Ihle C. et al. Smoking dependent alterations in bone formation and inflammation represent major risk factors for complications following total joint arthroplasty. J Clin Med 2019; 8 (03) 406-421
    Google Scholar
  • 30 Ackerman SJ, Knight T, Wahl PM. Projected Medicare savings associated with lowering the risk of total hip arthroplasty revision: an administrative claims data analysis. Orthopedics 2019; 42 (01) e86-e92
    CrossrefPubMedGoogle Scholar
  • 31 Reeves RA, Schairer WW, Jevsevar DS. The national burden of periprosthetic hip fractures in the US: costs and risk factors for hospital readmission. Hip Int 2019; 29 (05) 550-557
    CrossrefPubMedGoogle Scholar
  • 32 Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002; 359 (9301): 114-117
    CrossrefPubMedGoogle Scholar
  • 33 Hart A, Rainer WG, Taunton MJ, Mabry TM, Berry DJ, Abdel MP. Smoking cessation before and after total joint arthroplasty-an uphill battle. J Arthroplasty 2019; 34 (7S): S140-S143
    Google Scholar
  • 34 Boylan MR, Bosco III JA, Slover JD. Cost-effectiveness of preoperative smoking cessation interventions in total joint arthroplasty. J Arthroplasty 2019; 34 (02) 215-220
    Google Scholar
  • 35 Hart A, Rainer WG, Taunton MJ, Mabry TM, Berry DJ, Abdel MP. Cotinine testing improves smoking cessation before total joint arthroplasty. J Arthroplasty 2019; 34 (7S): S148-S151
    Google Scholar
  • 36 Singh JA, Schleck C, Harmsen WS, Jacob AK, Warner DO, Lewallen DG. Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study. BMC Med 2015; 13: 283-290
    Google Scholar
  • 37 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 (04) e0125294
    CrossrefPubMedGoogle Scholar