1103 GMT September 21, 2017
Those who use cigarettes are at an increased risk of requiring repeat procedures because of infections, say scientists.
The longer and the more they have smoked the bigger the danger, express.co.uk wrote.
Smoking has previously been linked to prolonged healing time and a greater risk of complications.
The latest findings published in The Journal of Bone and Joint Surgery suggest therapy may be needed for all patients considering joint replacements to encourage them to quit smoking.
The study of thousands of US patients found smokers were 80 percent more at risk repeat operations for septic complications.
Dr. Matthew Austin, of Thomas Jefferson University, Philadelphia, said: "Our results found current smokers had a significantly higher rate of septic reoperation compared with non smokers.
"Furthermore, each additional 'pack year' significantly contributed to total reoperations."
This is calculated by multiplying the number of packets of cigarettes smoked a day by the number of years the person has smoked.
For example, one pack year is equal to smoking 20 cigarettes (one pack) a day for a year, or 40 cigarettes a day for six months.
The study looked at how smoking history affected the risk of hospital readmissions among 15,264 patients.
They underwent 17,394 total joint replacements, either hip or knee, between 2000 and 2014 — 8,917 and 8,477, respectively.
At the time of surgery almost one in ten (nine percent) were current smokers, a third (34 percent) were former smokers and almost six in ten (57 percent) had never smoked.
Current smokers tended to be younger with an average age of about 58 compared to 63 for the non smokers. They also had higher rates of certain major respiratory and cardiovascular diseases.
The absolute risk of reoperation for infectious complications within 90 days was low, 0.71 percent. But this risk was much higher for current smokers, 1.2 percent against 0.56 percent for the others.
Former smokers were not at increased risk. But, for them and current smokers alike, the risk of being readmitted after 90 days for non operative reasons increased with their number of 'pack years'.
Smoking an extra pack a day for a decade was associated with a 12 percent increase in that relative risk.
The researchers said patients with a history of heavier smoking are also at increased risk, even if they have since quit smoking.
Austin added: "If smoking is associated with elevated perioperative risk of readmission and/or reoperation, then it may be reasonable to engage the patient in a smoking cessation program prior to total joint arthroplasty."
But further studies would be needed to determine whether quitting smoking before joint replacement surgery can reduce the risk of complications.