The effect of smoking on union rates following corrective osteotomies around the knee : a systematic review and meta-analysis
Al-Musabi, M Tahir, M Seraj, S Wasim, A Khadabadi, N Thakrar, R Hossain, F
Al-Musabi, M
Tahir, M
Seraj, S
Wasim, A
Khadabadi, N
Thakrar, R
Hossain, F
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Affiliation
The Robert Jones And Agnes Hunt Orthopaedic Hospital; Walsall Healthcare NHS Trust; East and North Hertfordshire NHS Trust
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Publication date
2023-07-20
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Abstract
Background: Distal femur osteotomies (DFO) and high tibial osteotomies (HTO), are well-established treatment options for joint preservation in active patients with uni-compartmental osteoarthritis. Optimal outcomes are contingent on adequate preoperative evaluation of patient-specific factors. This systematic review and meta-analysis aims to explore the difference in union rates between smokers and non-smokers following corrective osteotomies around the knee.
Methods: A systematic search of the MEDLINE and EMBASE databases was performed in accordance with the PRISMA guidelines to identify studies reporting smoking status in adults who developed delayed and/or non-union following HTO or DFO. Studies were pooled using a random effect model [Review Manager (RevMan) software, V.5.4] and heterogeneity was estimated using I2.
Results: Data for meta-analysis was available for 1,406 osteotomies from 10 studies, performed in patients with mean age ranging from 38-54 years, and 65% were male. The union rate among non-smokers was 97.3% (1100/1131) compared with 89.5% (246/275) among smokers; OR 4.59 [95% CI 1.99 to 10.62], p-value < 0.001. Subgroup analysis revealed that the risk of non-union in smokers after opening wedge osteotomy was almost double (OR 4.8) that of closing wedge osteotomies (OR 2.9).
Conclusion: Smoking increases the risk of non-union during elective knee osteotomy surgery. Our findings also suggest that smokers have a better chance of achieving union with closing wedge osteotomy compared to open wedge osteotomy.
Citation
Al-Musabi M, Tahir M, Seraj S, Wasim A, Khadabadi N, Thakrar R, Hossain F. The effect of smoking on union rates following corrective osteotomies around the knee: A systematic review and meta-analysis. Knee. 2023 Jul 20;44:11-20.
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Article