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Choosing to quit smoking before joint replacement surgery is one of the most useful things you can do to protect your new hip or knee. It is also a change you fully control, unlike your age or the shape of your joint.
In my practice, when a patient who smokes tells me they are ready for surgery, we have an honest, supportive conversation first. Quitting is hard. I am not here to shame anyone. I am here to give you a realistic plan, because the difference in healing is real and worth it.
Why Should You Quit Smoking Before Joint Replacement Surgery?
You should quit because smoking and nicotine slow down bone and wound healing right where your body has to do the most work after surgery. A joint replacement is a major event. I cut and reshape bone, place an implant, and then your body has to heal the bone, the soft tissue, and the incision.
That healing depends on a steady supply of oxygen-rich blood. Smoking works directly against that. Nicotine narrows your blood vessels and reduces blood flow, while carbon monoxide lowers the oxygen your blood can carry. Less oxygen at the surgical site means slower healing, weaker scar tissue, and a higher chance of infection.
How Does Smoking Slow Bone and Wound Healing?
Smoking slows healing in three ways at once: it starves tissue of oxygen, it weakens your immune response, and it interferes with the bone cells that grow into the implant.
What does nicotine do to your blood supply?
Bone heals through cells called osteoblasts, which build new bone around your implant. Nicotine slows those cells down, so the bone takes longer to grow strong and stable. Without that ingrowth, an implant can stay loose.
Tobacco smoke also weakens your immune response. White blood cells, which fight infection, move more slowly in smokers. That combination of poor blood flow, slow bone healing, and a sluggish immune system is why smoking is often the single biggest risk factor for an implant that does not heal the way it should.
What Are the Real Risks of Smoking and Joint Replacement?
The numbers are consistent and hard to ignore. A large review combining 14 studies found that tobacco users had about 1.78 times the odds of a wound complication and 2.16 times the odds of a deep joint infection compared with non-users.
Active smokers also face up to 1.5 to 3.2 times the risk of wound-related problems, and up to 1.8 times the risk of a prosthetic joint infection. An infection around an implant is one of the most serious complications in joint replacement, and it can mean more surgery.
Smoking affects recovery in other ways too. Compared with non-smokers, smokers tend to need more opioid pain medicine, stay in the hospital longer, and report more pain after a hip or knee replacement. A 2026 study of more than 1,100 total knee replacement patients found that people who were still smoking at surgery reported higher pain scores and were less likely to reach a comfortable recovery state than former and never-smokers.
How Long Before Surgery Should You Quit Smoking?
Aim to quit 4 to 6 weeks before surgery and stay smoke-free for at least 4 weeks after. Research shows that quitting for four to six weeks before surgery and staying smoke-free for four weeks after can cut your complication risk by up to 50 percent.
That is a remarkable return for a few weeks of effort. If six weeks is not realistic for you, do not give up on the idea. Even one or two weeks smoke-free lowers your risk during and after surgery.
A Simple Timeline to Quit Smoking Before Joint Replacement Surgery
- 6 weeks before: Set a quit date and tell your primary care doctor or surgeon. Ask about support tools.
- 4 weeks before: Aim to be fully smoke-free and nicotine-free.
- Surgery week: Stay off all tobacco and nicotine products.
- 4 weeks after: Keep going. This is when your bone and wound are healing hardest.
- Beyond: Use quitting as the reset it can be. Many patients who quit for surgery never go back.
What If You Cannot Quit Completely?
Tell me anyway, and we plan around it. This is the question I hear most, and honesty helps. The harmful effects come largely from nicotine, so vaping and chewing tobacco carry many of the same risks as cigarettes. The aim is still to stop nicotine products before surgery, vaping included.
Some surgical programs even test for nicotine before surgery to confirm you are clear. If you truly cannot stop, you should still know the risks so you can make an informed choice with me and your care team. People with severe arthritis sometimes need relief even when quitting is not possible, and we work through that together.
Do Vaping and Chewing Tobacco Carry the Same Risk?
Yes. Nicotine is the problem, not just the smoke. Vaping delivers nicotine that narrows blood vessels and slows healing exactly like a cigarette does. Chewing tobacco and dip do the same.
Nicotine replacement therapy, such as patches or gum, is a separate conversation. It still delivers nicotine, but under a doctor’s guidance it can be a useful bridge to quitting, and it is generally better than continuing to smoke. Talk with your surgeon and primary care doctor about the right approach for you.
What Actually Helps You Quit?
A combination of counselling and medication works best, and most people need more than one try. Most people do not quit on willpower alone, and that is normal. Pairing quit-smoking medicine with coaching gives the strongest odds.
An upcoming surgery is one of the strongest motivators there is. In one study of patients who quit specifically to prepare for joint replacement, about one in four stayed smoke-free for good. The catch is that more than half of relapses happen within the first three months after surgery, so plan ahead for that window.
Free help is available. You can call the national quit line at 1-800-QUIT-NOW (1-800-784-8669) or start with the American Lung Association. Your doctor can connect you with local cessation programmes, nicotine replacement therapy, or prescription options. If you are still weighing whether surgery is right for you, our guide to the disadvantages of hip replacement walks through the honest trade-offs.
Quitting Smoking Before Surgery in Middle Tennessee
If you are preparing for a hip or knee replacement near home, I practice at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067. I care for patients across Franklin, Nashville, Columbia, Spring Hill, Nolensville, and the broader Middle Tennessee region.
I perform anterior-approach total hip replacement and robotic-assisted joint replacement using the Mako® platform. (I disclose a paid consulting relationship with Stryker, the maker of the Mako system.) If you smoke and surgery is on your mind, bring it up at your first visit. We will build a realistic plan together, and whether you let us modern tools such as robotic joint replacement, quitting smoking gives every technique its best chance to succeed.
Planning a hip or knee replacement?
Build a smoke-free plan with a fellowship-trained joint replacement surgeon.
or call (615) 791-2630
This article is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified orthopaedic surgeon or healthcare provider about your individual situation, including before starting or stopping any medication or nicotine product. Individual results may vary.
Watch: The Truth About Smoking and Total Knee Replacement Recovery
References
- Bedard NA, DeMik DE, Owens JM, et al. Tobacco use and risk of wound complications and periprosthetic joint infection: a systematic review and meta-analysis of primary total joint arthroplasty procedures. J Arthroplasty. 2019;34(2):385-396.
- Duchman KR, Gao Y, Pugely AJ, et al. The effect of smoking on short-term complications following total hip and knee arthroplasty. J Bone Joint Surg Am. 2015;97(13):1049-1058.
- Matharu GS, Mouchti S, Twigg S, et al. The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients. Acta Orthop. 2019;90(6):559-567.
- Major EL, Goetz JR, Stone HT, et al. Impact of smoking status on early outcomes and healthcare utilization following primary total knee arthroplasty: a retrospective cohort study. J Arthroplasty. 2026 (in press).
- American Academy of Orthopaedic Surgeons. Smoking and musculoskeletal health. OrthoInfo. Accessed 2026.
- American Association of Hip and Knee Surgeons. It is important to stop smoking before knee replacement. hipkneeinfo.org. Accessed 2026.
