title: Smoking may be a harbinger of early failure with ultraporous metal acetabular reconstruction.
abstract: BACKGROUND
  Smoking is considered a risk factor for surgical complications in total hip arthroplasty (THA) and has been linked to a higher rate of aseptic loosening in uncemented acetabular components. Acetabular reconstruction with newer ultraporous metals in both complex primary and revision THA has increased survivorship but it is unclear whether smoking affects survival of these implants.
  
  
  OBJECTIVE
  We reviewed our early experience with THA using ultraporous acetabular components to assess the incidence and etiology of early failure and examine if any preoperative variables, including smoking, related to failure.
  
  
  METHODS
  We used ultraporous acetabular components in 498 patients (534 hips), beginning with one case each in 1999 and 2004, 17 in 2005, and the majority from 2006 through March 2010. There were 159 complex primary and 375 revision cases. Of these patients, 17% were smokers (averaging 35 pack-years), 31% previous smokers (averaging 29 pack-years), 41% nonsmokers, and 1% unknown. Failure modes possibly related to smoking were infection, aseptic loosening, or periacetabular fracture and unrelated were dislocation and implant breakage. Minimum followup was 1 month (average, 32 months; range, 1-78 months).
  
  
  RESULTS
  There were 34 cup failures (6%): 17 infections, 14 aseptic loosening, and one each liner breakage, dislocation, and periacetabular fracture. The failure rate (uncontrolled for potentially confounding variables) was 10% in both current (9 of 89) and prior smokers (17 of 167) and 3% in nonsmokers 8 of 271).
  
  
  CONCLUSIONS
  With ultraporous metal technology in complex primary and revision THA, smoking, both past and current, may be a risk factor for early failure.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Joint Implant Surgeons, Inc, New Albany, OH, USA. lombardiav@joint-surgeons.com
authors.forename: Adolph V
authors.initials: AV
authors.lastname: Lombardi
authors.forename: Keith R
authors.initials: KR
authors.lastname: Berend
authors.forename: Joanne B
authors.initials: JB
authors.lastname: Adams
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Jefferson
authors.forename: Michael A
authors.initials: MA
authors.lastname: Sneller
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006621:Hip Joint / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
chemical_list: D008670:Metals