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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.

Original publication

DOI

10.1002/jor.22603

Type

Journal article

Journal

Journal of orthopaedic research : official publication of the Orthopaedic Research Society

Publication Date

06/2014

Volume

32

Pages

762 - 768

Addresses

Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals and Geneva University, Rue Gabrielle-Perret-Gentil, Geneva, CH-1211, Switzerland.

Keywords

Humans, Hypersensitivity, Delayed, Prosthesis Failure, Metals, Polyethylenes, Ceramics, Arthroplasty, Replacement, Hip, Reoperation, Risk Factors, Cohort Studies, Follow-Up Studies, Prospective Studies, Prosthesis Design, Hip Prosthesis, Smoking, Aged, Middle Aged, Female, Male