Do smokers achieve the same clinically meaningful improvement after total hip arthroplasty?

PURPOSE: The effect of smoking on patient-reported outcome measures (PROMs) after primary total hip arthroplasty (THA) has not been fully established. The aim of this study is to evaluate the effect of active smoking on postoperative functional outcomes and quality of life. METHODS: A retrospective study was conducted on 950 patients who underwent primary THA between January 2020 and January 2023. Patients were divided into two groups: smokers (n = 115) and non-smokers (n = 835). All patients underwent preoperative and 12-month postoperative evaluations of EQ-5D-5L, EQ-VAS, and Hip Disability and Osteoarthritis Outcome Score (HOOS). Multivariate linear regression analysis was used to determine the independent effect of smoking. RESULTS: No significant differences were found between the groups in terms of age, gender, BMI, and follow-up duration (all p > 0.05). All PROM scores were similar in the preoperative period. At the 12-month postoperative evaluation, non-smoking patients achieved significantly higher scores on the EQ-5D-5L (0.83 ± 0.10 vs. 0.76 ± 0.12; p < 0.001), EQ-VAS (76.5 ± 13.6 vs. 69.0 ± 15.1; p < 0.001), and all HOOS subscales. Preoperative-postoperative change (Δ) scores were also higher in non-smokers. In multivariate analysis, smoking was independently associated with lower EQ-5D-5L, EQ-VAS, and HOOS quality of life scores (all p < 0.001). CONCLUSIONS: Active smoking is associated with lower patient-reported outcomes and more limited functional gains after primary THA. Our study contributes to the existing literature by revealing the effect of smoking on arthroplasty outcomes not only in terms of complications but also from the perspective of patient-perceived healing.