Evaluating the role of cotinine measurements in total joint arthroplasty

Mixed retrospective-prospective design. The purpose of this study was to evaluate the accuracy of self-reported smoking cessation prior to total joint arthroplasty and explore potential patient and procedural factors influencing discrepancies, assessing the utility of cotinine testing in perioperative management. Smoking negatively affects surgical outcomes, including wound healing, infection rates, and perioperative complications. While patients are typically advised to quit smoking at least one month before arthroplasty, compliance is often assessed through self-reported smoking status. However, perioperative cotinine testing, a reliable biomarker for nicotine use, offers an objective measure of cessation. We retrospectively and prospectively analyzed data from 75 patients who underwent total joint arthroplasty between 2014 and 2024 at a single academic center. Urine cotinine tests were obtained before surgery to confirm self-reported nicotine cessation. Patient characteristics were compared to cotinine test results in SPSS using a t -test and Fisher's exact test. A total of 75 patients were included (mean age 59; 56 % male; 47 % Hispanic or Latino). Consistency between self-reported smoking cessation and cotinine test results was observed in 83 % of patients. Demographic factors and smoking frequency did not have statistically significant associations with cotinine results. The greatest discrepancy between self-report and cotinine test results among patients undergoing primary total knee arthroplasty (33.3 %). Self-reported smoking cessation demonstrates moderate reliability when compared to urine cotinine testing before total joint arthroplasty (TJA). Patients undergoing total knee arthroplasty exhibited higher rates of discordance between self-report and cotinine testing compared to those undergoing total hip arthroplasty or revision arthroplasty, though this finding requires validation in larger studies. Future research should validate these preliminary observations in multicenter cohorts and explore the underlying mechanisms before informing preoperative verification strategies.