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How Can Smoking Affect My Knee Osteoarthritis?

14th March 2022

It is possible to manage knee osteoarthritis through a healthy diet and exercise, especially in the early stages. This also means it can easily worsen with bad personal habits. Smoking is perhaps the number one habit that severely impacts the progression of knee osteoarthritis. This blog summarises the current clinical findings, and includes tips and actionable tools to quit smoking.

Smoking and OA

How Does Smoking Affect Knee OA?

A multitude of studies indicate that smoking has a negative impact on knee osteoarthritis.

Preliminary cell and animal studies showed that tobacco smoke disrupted chondrocyte function in discs. Chondrocyte is necessary for the production and integrity of cartilage, so its malfunction negatively affected collagen and proteoglycan synthesis in cartilage matrix [1].

Since nicotine hinders cartilage production and repair, it inevitably causes cartilage loss in the knee. Simply put, smoking accelerates the progression of knee osteoarthritis.

Research also suggests that smoking reduces blood oxygenation in arteries going through the knee. As a result, the lack of oxygen in the knee disrupts the repair and regeneration process.

Over the past two decades, these theories have been backed numerous times by clinical studies.

In a 2007 study, the knee OA progression of 159 participants was tracked for 30 months. Among the participants, 19 were smokers. At the end of 30 months, it was observed that the participants who smoked regularly had more than twice as much cartilage loss at medial tibiofemoral and patellofemoral joints. Also, they experienced significantly more severe joint pain, despite being younger than the rest of the participants [2].

A larger study was conducted in 2017 with 2250 participants, 44% of which were either current or former smokers. After 72 months, the 44% group experienced greater stiffness and pain than those who never smoked before [3].

Not only does smoking exacerbate knee OA symptoms, but it also interferes with knee OA treatments. One study from 2012, involving 621 participants, explored the relationship between cigarette smoking and total knee replacement success rate. The researchers found that the patients who were smokers were 10 times more likely to undergo revision due to implant failure [4]. In 2014, another study with 7926 patients reported increased smoking-related risks of tissue infection and implant revision after total knee arthroplasty [5].

There are small scale studies, which either found no correlation between smoking and knee OA, or found positive effects of mild smoking of chondrocyte function. Nevertheless, these are outnumbered by the studies supporting the harmful effects of nicotine on knee OA. Considering the various other proven health effects of cigarette smoking, from lung cancer to cardiovascular diseases, we strongly advise against tobacco use.

If you are currently a regular smoker wanting to quit, here are some steps you can follow:

  • Nicotine replacement therapies: There are a variety of over-the-counter and prescription drugs. Consult with your doctor to find out which ones are suitable for you.
  • Identify your triggers: You might be tempted to smoke in stressful situations or when socializing. Knowing when cravings appear can give you the upper hand to take action.
  • Crunchy and chewy snacks, such as nuts, carrots, seeds, and gum, can help alleviate cravings.
  • Exercise will be one of your best friends while quitting cigarettes. In addition, low impact exercises like cycling, swimming, and walking can directly reduce your knee OA symptoms by strengthening your leg muscles.
  • Support from family and friends is crucial during this period, so don’t hesitate to ask them to encourage you.
  • Seek therapy if needed. Cognitive behavioral therapy has been shown to help combat tobacco addiction.

[1] Iwahashi, Masaki et al. “Mechanism of intervertebral disc degeneration caused by nicotine in rabbits to explicate intervertebral disc disorders caused by smoking.” Spine vol. 27,13 (2002): 1396-401. doi:10.1097/00007632-200207010-00005

[2] Amin, S et al. “Cigarette smoking and the risk for cartilage loss and knee pain in men with knee osteoarthritis.” Annals of the rheumatic diseases vol. 66,1 (2007): 18-22. doi:10.1136/ard.2006.056697

[3] Dubé, C E et al. “The relationship between smoking and knee osteoarthritis in the Osteoarthritis Initiative.” Osteoarthritis and cartilage vol. 24,3 (2016): 465-72. doi:10.1016/j.joca.2015.09.015

[4] Kapadia, Bhaveen H et al. “Increased revision rates after total knee arthroplasty in patients who smoke.” The Journal of arthroplasty vol. 27,9 (2012): 1690-1695.e1. doi:10.1016/j.arth.2012.03.057

[5] Singh, Jasvinder A et al. “Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study.” BMC medicine vol. 13 283. 19 Nov. 2015, doi:10.1186/s12916-015-0523-0

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