title: Strong association between smoking and the risk of revision in a cohort study of patients with metal-on-metal total hip arthroplasty.
abstract: Thus far the ability to predict who will develop early failure following the insertion of a metal-on-metal (MoM) bearing has been very limited. Our objective was to assess the effect of smoking on failure rates in patients with MoM bearing, compared with patients with ceramic-on-polyethylene (CoP) bearing. From a prospective hospital-based registry we included all primary THAs operated upon between 1/2001 and 12/2011 with MoM or CoP bearings of the same cup design and head size (28 mm). We compared revision rates through 10/2013 classified by smoking status and type of bearing. We included 1,964 patients (median age 71, 57% women), 663 with MoM and 1,301 with CoP bearing. Mean follow-up was 6.9 years (range 1.8-12.8). Revisions were required for 56 THAs. In patients with MoM bearing the adjusted incidence rate of revision among ever-smokers was four times greater than among never-smokers (95% CI 1.4-10.9). Among those with CoP bearing, the rate ratio was only 1.3 (95% CI 0.6-2.5). We found a strong association between smoking and increased failure of MoM THAs. In contrast, the association was weak for patients with CoP bearing. Smoking might be a trigger or an effect amplifier for adverse reactions to metal debris from MoM bearings.
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals and Geneva University, Rue Gabrielle-Perret-Gentil, Geneva, CH-1211, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Lübbeke
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Rothman
authors.forename: Guido
authors.initials: G
authors.lastname: Garavaglia
authors.forename: Christophe
authors.initials: C
authors.lastname: Barea
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Christofilopoulos
authors.forename: Richard
authors.initials: R
authors.lastname: Stern
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002516:Ceramics; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology; D008297:Male; D008670:Metals / Q000276:immunology; D008875:Middle Aged; D011095:Polyethylenes; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
chemical_list: D008670:Metals; D011095:Polyethylenes
keywords: ALTR; metal hypersensitivity; metal-on-metal hip arthroplasty; revision; smoking