The landscape of primary total knee arthroplasty (TKA) is undergoing a massive structural shift. Driven by advanced bio-materials, precision instrumentation, and the emergence of highly porous titanium manufacturing, cementless (press-fit) fixation pathways are surging in popularity, capturing approximately 14% of the U.S. market in 2020. The theoretical promise is immense: by eliminating degrading polymethylmethacrylate bone cement, a cementless implant achieves a living, biological osseointegration that could functionally eradicate late aseptic loosening.
However, achieving that living biologic bond requires an optimized physiological host. It is universally understood that tobacco use inflicts catastrophic damage on soft-tissue healing and dramatically increases the risk of deep periprosthetic joint infection, pseudoarthrosis in spinal fusions, and aseptic loosening in traditional cemented joints. Nicotine acts as a potent vasoconstrictor, while elevated carbon monoxide severely limits oxygen-carrying capacity, resulting in a hypoxic environment at the cellular level.
