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Smoking and knee surgery


Many smokers depend on the stimulating effects of nicotine. These can include boosting your mood, improving short-term memory and concentration, and producing a sense of well-being.

However, by quitting tobacco before your surgery, you are more likely to have a successful surgery and recovery.

Most smokers in the United States would like to quit smoking. Most people who have quit smoking have made at least one unsuccessful quit attempt in the past. Try to view past attempts to quit as learning experiences, not failures.

Smoking and knee replacement surgery

After knee replacement surgery, there is an increased chance of blood clots forming in the legs. These clots may travel to the lungs. Smoking increases the risk of blood clots forming.

When you smoke, less oxygen reaches the cells in your surgical wound. As a result, your wound may heal slowly and may even become infected.

All smokers are at risk for heart and lung problems. Even when your knee replacement surgery goes smoothly, it places more demand on your body, heart, and lungs.

Surgery and anesthesia may cause congestion in the lungs (atelectasis). The risk of lung congestion is greatly increased in smokers.

There are many reasons to quit using tobacco

When used for a long time, tobacco and chemicals such as tar and nicotine can increase your risk of many health problems:

  • Blood clots and aneurysms in the brain, which can lead to strokes
  • Coronary artery disease, including angina and heart attacks
  • High blood pressure
  • Poor blood supply to the legs
  • Cancer (lung, mouth, larynx, esophagus, bladder, kidney, pancreas, and cervix)
  • Lung problems, such as emphysema and chronic bronchitis or asthma that is harder to control
  • Problems with erections

Some smokers will switch to smokeless tobacco instead of quitting tobacco completely. However, there are other risks with smokeless tobacco:

  • Increased risk of mouth or nasal cancer
  • Gum problems, tooth wear, and cavities
  • Worsening high blood pressure and angina

Making the decision to quit

Most doctors want you to stop cigarettes and tobacco at least 4 weeks before your knee replacement. Do not be discouraged, even if you have smoked for a long time. Quitting smoking 10 weeks or more before surgery can lower your risk of problems even more.

Quitting tobacco is not easy. It can be even harder if you are trying to do it on your own. There are many ways to quit smoking and many resources to help you.

  • Family members, friends, and coworkers may provide support or encouragement.
  • Talk with your doctor about nicotine replacement therapy and smoking cessation medicines.
  • If you join a smoking cessation program, you have a much better chance of success. These programs are offered by hospitals, health departments, community centers, and work sites.
  • Using nicotine gum around the time of surgery is not encouraged. The nicotine will still interfere with healing of your surgical wound.
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Review Date: 8/9/2018

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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