Osteoarthritis and rheumatoid arthritis are the most ubiquitous joint disorders which cause tremendous loss of life quality and impose an economic burden on society. At present, the treatment options for these two diseases comprise non-operative and surgical treatments, amongst those total knee arthroplasties (TKA). Various studies have recognized smoking as a significant risk factor for postoperative complications. Therefore, the purpose of this study was to examine the impact of smoking on the incidence and postoperative complications after a total knee arthroplasty by a systematic review and meta-analysis. The research was performed using PUBMED, Cochrane Library and EMBASE, extracting data from thirteen suitable studies and incorporating 2,109,482 patients. Cohort studies evaluating the impact of smoking on TKA with sufficient data were included for the study, and cohort studies without a proper control group and complete data were excluded. A fixed-effects or random-effects model was used to measure the pooled risk ratio (RR) or hazard ratio (HR) with 95% confidence interval (CI). Compared to non-smokers, smokers had a significantly lower incidence of TKA (p<0.01). However, smokers had a higher incidence of total complications (p=0.01), surgical complications (p<0.01), pneumonia (p<0.01) and revision surgery (p=0.01). No significant difference in the risk of blood transfusion (p=0.42), deep vein thrombosis (p=0.31), pulmonary embolism (p=0.34), urinary tract infection (p=0.46) or mortality (p=0.39) was found between smokers and non-smokers. In conclusion, the study indicated that tobacco has two diametrically opposite effects on TKA patients: 1. Tobacco increases the incidence of surgical complications, pneumonia and revision after TKA; 2. It decreases the overall risk of being a candidate for TKA.

中文翻译：

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吸烟对全膝关节置换术发生率和术后并发症的影响：队列研究的系统回顾和荟萃分析。

骨关节炎和类风湿性关节炎是最普遍的关节疾病，它们会造成巨大的生活质量损失并给社会带来经济负担。目前，这两种疾病的治疗选择包括非手术治疗和手术治疗，其中包括全膝关节置换术（TKA）。各种研究已经认识到吸烟是术后并发症的重要危险因素。因此，本研究的目的是通过系统评价和荟萃分析来检验吸烟对全膝关节置换术后发生率和术后并发症的影响。该研究是使用 PUBMED、Cochrane Library 和 EMBASE 进行的，从 13 项合适的研究中提取数据并纳入 2,109,482 名患者。该研究纳入了评估吸烟对TKA影响的具有足够数据的队列研究，排除了没有适当对照组和完整数据的队列研究。使用固定效应或随机效应模型来测量具有 95% 置信区间 (CI) 的汇总风险比 (RR) 或风险比 (HR)。与非吸烟者相比，吸烟者的TKA发生率显着降低（p<0.01）。然而，吸烟者的总并发症（p=0.01）、手术并发症（p<0.01）、肺炎（p<0.01）和翻修手术（p=0.01）的发生率较高。输血（p=0.42）、深静脉血栓形成（p=0.31）、肺栓塞（p=0.34）、尿路感染（p=0.46）或死亡率（p=0.39）的风险无显着差异。吸烟者和非吸烟者。综上所述，研究表明，烟草对 TKA 患者有两种截然相反的影响： 1. 烟草会增加 TKA 术后手术并发症、肺炎和翻修的发生率；2. 它降低了成为 TKA 候选人的总体风险。