title: Nicotine consumption may lead to aseptic loosening in proximal mega-prosthetic femoral replacement.
abstract: BACKGROUND
  Aseptic loosening after total hip arthroplasty is likely related to nicotine ingestion. However, aseptic loosening as a direct consequence of smoking habits has not been described with regard to proximal mega-prosthetic femoral replacement. The aim of the present study was to evaluate the association between nicotine consumption and aseptic loosening rates after proximal mega-prosthetic femoral replacement.
  
  
  METHODS
  A consecutive series of patients who received mega-prosthetic replacement of the proximal femur at our hospital between 2005 and 2015 were included. Their files were reviewed and evaluated for the influence of smoking on aseptic loosening rates. All living patients were invited to complete a functional follow-up assessment at our clinic.
  
  
  RESULTS
  Twenty-six patients with 27 prostheses were included. Five patients were active smokers, and 21 patients were non-smokers. Aseptic loosening was observed in three patients in the smoking group, whereas none of the non-smokers developed aseptic loosening. Fisher's exact test showed a relationship between nicotine consumption and aseptic loosening of the prostheses (p = 0.003).
  
  
  CONCLUSIONS
  Smoking increases the likelihood of aseptic loosening after proximal mega-prosthetic femoral replacement.
  
  
  METHODS
  Level 4 according to Oxford Centre of Evidence-Based Medicine 2011.
authors.affiliation: Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. philipleute@googlemail.com.
authors.forename: Philip J F
authors.initials: PJF
authors.lastname: Leute
authors.affiliation: Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Hoffmann
authors.affiliation: Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hammad
authors.affiliation: Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lakemeier
authors.affiliation: Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Klinger
authors.affiliation: Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.|Department of Orthopedic Surgery, Helios Aukammklinik, Leibnizstraße 21, 65191, Wiesbaden, Germany.
authors.forename: Mike H
authors.initials: MH
authors.lastname: Baums
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D003430:Cross-Sectional Studies; D005260:Female; D005271:Femur Head Necrosis / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*
chemical_list: D009538:Nicotine
keywords: Aseptic; Complication; Femur; Loosening; Nicotine; Proximal; Replacement; Smoking