🚭Smoking and Wound Healing
Smoking is one of the biggest modifiable risk factors in joint replacement surgery. Stopping — even a few weeks before your operation — has a measurable impact on wound healing and complication rates.
What smoking does to healing
Nicotine narrows blood vessels and reduces oxygen delivery to healing tissue. This slows wound healing and increases the risk of infection and delayed bone healing.
Smokers have a significantly higher rate of wound complications and revision surgery compared with non-smokers.
Practical support
Ideally, stop smoking at least four to eight weeks before surgery. Any period of abstinence helps.
NHS Stop Smoking Services offer free support, and nicotine replacement therapy is safe to use around surgery.
Why stopping smoking before knee replacement matters
Preparing for a knee replacement is about more than the operation itself.
One of the most important things you can do before surgery is stop smoking.
Smoking affects almost every stage of recovery, from wound healing and infection risk to how well your new knee functions after surgery.
The good news is that stopping smoking — even a few weeks before surgery — can reduce many of these risks.
How does smoking affect healing?
Cigarettes, vaping products containing nicotine and other tobacco products reduce the body's ability to heal. Nicotine narrows blood vessels and carbon monoxide reduces the oxygen carried by your blood — both are essential for healing tissue.
- Reduced oxygen reaching tissues
- Narrowing of blood vessels
- Slower wound healing
- Reduced collagen production
- Reduced immune function
- Increased inflammation
- Reduced bone healing
Wide, open blood vessels deliver plenty of oxygen and nutrients to healing tissue.
Narrowed vessels and lower oxygen levels slow wound healing and weaken the immune response.
Why does this matter for knee replacement?
Wounds heal more slowly
Smoking reduces blood supply to the skin and tissues around the knee, increasing the chance of delayed wound healing.
Infection risk increases
Smoking weakens the immune system, making it harder to fight bacteria after surgery.
Bone and implant healing
Healthy bone is needed for long-term implant stability. Smoking interferes with normal bone metabolism and healing.
Recovery may be slower
- More pain
- Reduced mobility
- Slower rehabilitation
- Poorer overall knee function
A large study of more than 78,000 hip and knee replacements found that:
- Current smokers had significantly more wound complications
- Smokers had almost 50% higher odds of wound complications
- The more someone had smoked over their lifetime (pack-years), the greater their risk of complications
Reference: Duchman et al. (2015)
Smoking doubles the risk of joint infection
Research combining results from multiple studies found that:
- Smokers had approximately 78% higher risk of wound complications
- Smokers had approximately double the risk of prosthetic joint infection
- Former smokers had lower risks than people who continued smoking
Stopping smoking before surgery reduced these risks significantly.
Reference: Bedard et al. (2019)
Smoking affects how well your new knee works
Smoking influences not only complications but also long-term recovery. Recent research has shown that current smokers had:
- Poorer pain scores
- Worse knee function
- Reduced range of motion
- Lower Knee Society Scores
Former smokers performed almost as well as people who had never smoked.
Reference: Parry et al. (2025)
The benefits begin quickly
- Carbon monoxide levels fall
- Blood oxygen improves
- Blood circulation improves
- Lung function begins to recover
- The immune system becomes more effective
- Wound healing improves
- Surgical risks begin to reduce
- Many hospitals recommend stopping for at least 4–8 weeks before surgery where possible
- Lower infection risk
- Better overall health
- Improved heart and lung function
- Better long-term recovery after knee replacement
Will quitting really make a difference?
Yes.
Research shows that former smokers have lower complication rates than people who continue smoking.
Even if you have smoked for many years, stopping before surgery helps your body recover.
It is never too late to benefit.
Tips to help you stop smoking
- Speak to your GP or practice nurse
- Use your local NHS Stop Smoking Service
- Consider nicotine replacement therapy if recommended
- Remove cigarettes and vaping products from your home
- Ask family and friends for support
- Set a quit date
- Celebrate small milestones
Frequently asked questions
Do I have to stop smoking before surgery?+
Not always, but stopping smoking is one of the most effective ways to reduce complications.
Is vaping safer?+
Nicotine in vaping products may still reduce blood flow and impair healing. Discuss nicotine use with your surgical team.
What if I've smoked for years?+
Stopping now still helps. Former smokers consistently have better outcomes than people who continue smoking.
Is it worth stopping just a few weeks before surgery?+
Yes. Even a few weeks without smoking improves oxygen levels, circulation and healing.
Every day without smoking helps
Quitting smoking before surgery gives your body the best opportunity to heal.
Many patients find that preparing for knee replacement provides the motivation to stop smoking permanently.
One study found that approximately one in four patients who stopped smoking for their joint replacement remained smoke-free long-term — making surgery an opportunity for lasting health benefits.
Reference: Hall et al. (2021)
Key takeaway
Stopping smoking before knee replacement is one of the most effective ways to improve your recovery.
It reduces the risk of wound complications, infection and delayed healing while improving the chances of a successful long-term outcome.
Even if you've smoked for many years, it is never too late to benefit from quitting.
References
- Bedard, N.A., DeMik, D.E., Owens, J.M., Glass, N.A., DeBerg, J. and Callaghan, J.J. (2019) Tobacco use and risk of wound complications and periprosthetic joint infection: A systematic review and meta-analysis of primary total joint arthroplasty procedures. Journal of Arthroplasty, 34(2), pp.385–396.e4.
- Duchman, K.R., Gao, Y., Pugely, A.J., Martin, C.T., Noiseux, N.O. and Callaghan, J.J. (2015) The effect of smoking on short-term complications following total hip and knee arthroplasty. Journal of Bone and Joint Surgery American, 97(13), pp.1049–1058.
- Hall, J.R.L., Metcalf, R., Leisinger, E., An, Q., Bedard, N.A. and Brown, T.S. (2021) Does smoking cessation prior to elective total joint arthroplasty result in continued abstinence? Iowa Orthopaedic Journal, 41(1), pp.141–144.
- Parry, D., Allen, J., Henderson, B., Kassab, J., Hernandez, E. and Brindley, G. (2025) The effect of tobacco use on clinical outcomes in total knee arthroplasty patients. Proceedings (Baylor University Medical Center), 38(2), pp.171–174.
Practical tips
- Set a quit date well before your pre-assessment appointment.
- Combine behavioural support with nicotine replacement for the best chance of success.
- Avoid vaping products in the immediate perioperative period unless discussed with your team.