Summary

Smoking is associated with worse patient-reported outcomes and decreased likelihood of returning to work following opening wedge high tibial or distal femoral osteotomy.

Abstract

Objective

High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are effective treatments for coronal plane knee deformities, with multiple studies demonstrating improved patient reported outcomes (PROs) and functional scores postoperatively. Tobacco use in the setting of HTO and DFO has been associated with an increased incidence of post-operative complications including wound dehiscence, surgical site infection, neuralgia, nonunion, and implant failure. However, previous studies have not evaluated the effects of tobacco use on PROs following HTO or DFO. Therefore, the purpose of this study was to assess the effects of smoking on PROs in patients undergoing HTO or DFO procedures.

Methods

Patients undergoing opening wedge HTO or DFO were identified. PROs, including Tegner Activity Score, International Knee Documentation Committee (IKDC) Score, Lysholm Score, and Visual Analog Scales (VAS), were recorded at a minimum of 2 years postoperatively. Data on sport activity, return to sports (RTS), work before injury, and return to work (RTW) were evaluated. Smoking status was analyzed as a dichotomous and continuous variable. Statistical analysis utilized linear regression, pooled t-tests, and Chi-square tests, with significance set at p < 0.05.

Results

170 patients were available for analysis, 122 of whom (71.76%) underwent HTO and 48 of whom (28.24%) underwent DFO. 46 patients were included in the smoking cohort, whereas the remaining 124 patients were included in the nonsmoking cohort. The median length of follow-up was 5.41 years (IQR: 3.61-7.83 years). When analyzed as a dichotomous variable, smoking was associated with decreased Tegner (P = 0.0339), and VAS satisfaction scores (P = 0.0230), although no significant difference was found in Lysholm (P = 0.1154), IKDC (P = 0.0545), or KOOS (P = 0.7733) instruments. Moreover, the smoking cohort had a decreased likelihood of RTW at a minimum of 2 years (P = 0.0240), despite the fact that there was no significant difference in pre-injury working status between groups (P = 0.4011). Regarding sport participation, no significant difference was observed between cohorts either preoperatively (P = 0.1795) or postoperatively (P = 0.5887). When analyzed as a continuous variable, a greater magnitude of tobacco consumption was associated with worse scores on Tegner (P = 0.0149), IKDC (P = 0.0089), Lysholm (P = 0.0252), and VAS satisfaction (P =0.0021). Moreover, increased smoking quantity was associated with a decreased likelihood of RTW (P = 0.0201) at a minimum 2-year follow up. Greater tobacco consumption was not significantly associated with KOOS (P = 0.9083), VAS pain (P = 0.0547), or RTS (P = 0.8476).

Conclusion

Tobacco use was significantly associated with worse patient-reported outcomes in the setting of coronal plane knee osteotomy. Moreover, a greater degree of tobacco consumption demonstrated a linear relationship with poor outcomes as the smoking frequency/quantity increased. Smokers also had a lower likelihood of returning to work within 2 years postoperatively. These findings emphasize the importance of smoking cessation preoperatively in patients undergoing HTO or DFO to optimize surgical outcomes and enhance long-term recovery.