Modifiable Risk Factors Increase Total Joint Replacement Risk

Being overweight and reporting vigorous physical activity increase the risk of undergoing total joint replacement (TJR); severe osteoarthritis (OA) is the most common indicator for this procedure. There is a strong inverse dose-response relationship between duration of cigarette smoking and risk of TJR.

Mnatzaganian and associates conducted a cohort study of 11,388 men who had undergone ultrasonographic screening for abdominal aortic aneurysm. Clinical data were integrated with hospital morbidity data and mortality records. Time to TJR was modeled on weight, height, socioeconomic status, comorbidity, vigorous or nonvigorous exercise, and years of smoking. The cohort was divided into 3 age-groups.

Being overweight was significantly associated with TJR, and smoking was inversely associated, showing dose-response relationships across quintiles of the distribution of weight and years of smoking, respectively, in all 3 age-groups. TJR was 42% to 51% less likely to occur in the men who had smoked for 48 years or more than in those who had never smoked. There was a positive association between vigorous exercise and TJR.

The authors noted that more research is needed to better understand the role of smoking in the pathogenesis of OA and the criteria that are used to determine whether patients should undergo TJR.

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