Nicotine consumption may lead to aseptic loosening in proximal mega-prosthetic femoral replacement

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. MATERIALS AND 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. LEVEL OF EVIDENCE: Level 4 according to Oxford Centre of Evidence-Based Medicine 2011. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10195-016-0426-7) contains supplementary material, which is available to authorized users.