What are the effects of smoking on my bones, ligaments and tissues? 

It is common knowledge that smoking can result in heart disease, chronic lung disease, cancers of the lungs, urinary system and mouth. However, many patients may not realize that smoking often directly effects muscles, bones and ligaments.  In spine surgery, smoking has been shown to increase complication rates.  In addition, even in non-operative spine patients, smoking significantly affects the health of the discs in the spine and contributes to degenerative disc disease and thus back pain.  The following section describes some of the unique orthopedic complications of smoking.

Orthopedic Effects of Smoking (from AAOS Now June 2012)

Increased risk of surgical infections

Delayed fracture healing: The risk of impaired bone healing in tibial shaft fractures has been estimated at 3 to 18 times higher in smokers. The results of a multicenter, randomized, controlled trial found that the odds of having a complication after a fracture of the upper or lower extremity was 2.5 times higher in smokers than in nonsmokers and rates of superficial infection in smokers were more than double those in nonsmokers.

After transmetatarsal amputation, bunionectomy, and hindfoot fusion, smokers have slower healing rates than nonsmokers. The impact of smoking on outcomes after hand surgery has also been reported. Smoking is associated with surgical site infections after hand surgery and with scaphoid fracture nonunions; the risk of nonunion is almost 4 times greater among smokers than nonsmokers.

Delayed healing in smokers also has been reported after anterior cruciate ligament repair, cartilage restoration procedures, and arthroscopic repair of hip labral tears.

Osteoporosis: Tobacco use also has been cited as a factor in lower bone mineral density and the development of osteoporosis.

AAOS Now June 2012 Issue


While quitting smoking permanently is best from a heart, lung, cancer risk, and orthopedic standpoint, research shows that quitting 6-8 weeks prior to elective surgery and during your rehabilitation period can substantially lower your risk of tobacco related complications as described above.  Please speak to your Family Physician about resources available to help you to quit smoking and see Alberta resources for quitting smoking.