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Background: The reported association of smoking with risk of undergoing a total joint replacement (TJR) due to osteoarthritis (OA) is not consistent. We evaluated the independent association between smoking and primary TJR in a large cohort. Methods: The electronic records of 54,288 men and women, who were initially recruited for the Second Australian National Blood Pressure study, were linked to the Australian Orthopaedic Association National Joint Replacement Registry to detect total hip replacement (THR) or total knee replacement (TKR) due to osteoarthritis. Competing risk regressions that accounted for the competing risk of death estimated the subhazard ratios for TJR. One-way and probabilistic sensitivity analyses were undertaken to represent uncertainty in the classification of smoking exposure and socioeconomic disadvantage scores. Results: An independent inverse association was found between smoking and risk of THR and TKR observed in both men and women. Compared to non-smokers, male and female smokers were respectively 40% and 30% less likely to undergo a TJR. This significant association persisted after controlling for age, co-morbidities, body mass index (BMI), physical exercise, and socioeconomic disadvantage. The overweight and obese were significantly more likely to undergo TJR compared to those with normal weight. A dose-response relationship between BMI and TJR was observed (P < 0.001). Socioeconomic status was not independently associated with risk of either THR or TKR. Conclusion: The strengths of the inverse association between smoking and TJR, the temporal relationship of the association, together with the consistency in the findings warrant further investigation about the role of smoking in the pathogenesis of osteoarthritis causing TJR. [ABSTRACT FROM AUTHOR]

Background We assessed risks of incident in-hospital complications and 1-year and 5-year mortality following elective primary total joint replacement ( TJR), focusing on obesity. Methods Longitudinal data from a population-based cohort of 819 men who had had TJR were integrated with validated hospital morbidity data and mortality records. Complications recorded in the index admission were classified as major or minor by 13 independent orthopaedic surgeons. Results Of 819 men (mean age 76.3 ( SD 4.5) years), 331 patients (40.4%) had an in-hospital complication from whom 155 (18.9%) had at least one major complication that was classified as potentially life threatening. Obesity and age were independently associated with increased risk of major complications. Compared with patients without complications, those with major complications experienced significantly greater mortality in 1 year (5.8% versus 1.2%, P = 0.001) and 5 years (16.8% versus 8.0%, P = 0.002) following TJR. In Cox regressions, age, Charlson Co-morbidity index and major complications were independently associated with 1-year mortality. Age and Charlson Co-morbidity index were also associated with 5-year mortality. Similarly, risk of dying within 5 years of TJR was higher among patients with class II obesity compared with patients with normal weight. The most frequently reported complications were those in the cardio-respiratory and general systems. Complications in the cardio-respiratory system significantly increased hazard of 1- and 5-year mortality. Conclusion The elderly and the obese are more likely to develop adverse outcomes following a primary TJR. Our findings may assist clinicians in better selecting elderly patients for surgery, and informing them about their individual level of risk. [ABSTRACT FROM AUTHOR]

Background: We retrospectively assessed the independent effects of patient and clinical factors on length of stay and all-cause 90-day, one-year, and two-year readmission following elective total joint replacement. We also evaluated the independent association between length of stay and readmission with postoperative five-year mortality. Methods: Longitudinal data from 819 men who had had total joint replacement were integrated with validated hospital morbidity data and mortality records. Length of stay, readmission, and mortality following total joint replacement were each modeled using multivariable proportional hazards regression. Results: Mean age at surgery was 76.3 ± 4.3 years. Median length of stay following total joint replacement decreased by 25% from 12 days in 1997-1998 to nine days in 2005-2007. Age, inhospital complications, total knee replacement, private hospital, and increased body weight were significantly associated with longer stay. A dose-response relationship between weight and length of stay was observed (P = 0.003). Crude 90-day, one-year, and two-year readmission rates were 17.3%, 47.4%, and 65.0%, respectively. Ninety-day readmission was associated with comorbidity, inhospital complications, and treatment in public hospitals. Age, comorbidity, socioeconomic disadvantage, and increased weight significantly increased the risk of one-year and two-year readmission. Patients with a body mass index ≥ 30 kg/m² were 34% more likely to be readmitted within two years compared with those having a body mass index of 18.5-24.9 kg/m². All-cause one-year and two-year readmission rates were significantly higher in patients undergoing a total knee replacement than those undergoing a total hip replacement. No independent associations between length of stay and all-cause readmission or mortality were observed. All-cause 90-day and one-year readmission independently increased the risk of long-term postoperative mortality. Conclusion: After adjusting for confounding factors, including age, comorbidity, obesity, and inhospital complications, length of stay was not independently associated with post-discharge readmission or death. We report that the obese, those having total knee replacement, and the socioeconomically disadvantaged are the highest consumers of hospital resources following elective total joint replacement in elderly men. Our findings may assist clinicians in better selection of elderly patients for surgery, and informing them about their individual level of risk. [ABSTRACT FROM AUTHOR]