Vaping and E-Cigarettes in Orthopaedic Surgery Outcomes: A Systematic Review
Abstract
Introduction: The detrimental impact of traditional tobacco smoking on orthopedic surgical outcomes has been extensively documented,
with evidence linking smoking to impaired bone healing, delayed union, higher infection rates, and poorer functional recovery. In recent
years, electronic cigarettes (e-cigarettes) and vaping have emerged as increasingly popular alternatives, often perceived as safer substitutes
for conventional smoking. Despite their widespread use, the biological effects of e-cigarettes on musculoskeletal health and surgical
recovery remain insufficiently understood. Preclinical studies suggest that exposure to nicotine and other aerosolized chemicals may
disrupt bone metabolism, angiogenesis, and wound healing, thereby raising concerns for orthopedic patients. Given the rapid rise in
e-cigarette consumption among adults and the critical importance of optimal recovery after orthopedic surgery, a systematic evaluation of
existing evidence is warranted.
Methods: A systematic review was conducted using the PRISMA method to evaluate the association between e-cigarette/vaping use and
non-tobacco nicotine dependence in common orthopaedic procedures. This includes rotator cuff repair, spine surgeries, foot and ankle
procedures, total knee arthroplasty, total hip arthroplasty, femur intertrochanteric nailing etc. We focused on studies written in the last 10
years, between 2015 and 2025. Perioperative complications include impaired wound healing, bone healing.…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 175,000 participants or records.
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