No delayed bone healing in Swedish male oral snuffers operated on by the hemicallotasis technique: A cohort study of 175 patients

BACKGROUND AND PURPOSE: The effect of oral snuff on bone healing is virtually unknown. In vitro data have indicated that delay in bone healing in smokers may be the result of components of smoke other than nicotine. We compared the time for bone healing after high tibial osteotomy in snuffers, smokers, and in control subjects who did not use snuff or cigarettes. PATIENTS AND METHODS: 175 male patients comprising 41 smokers, 21 oral snuff users, and 113 non-smokers/non-snuffers, all of whom were operated on for knee deformity by tibial osteotomy using the hemicallotasis technique (HCO) between 2000 and 2005, were included in a consecutive manner. Preoperative tobacco use, postoperative complications, and treatment time in external fixation were documented. RESULTS: There was no delayed healing in the oral snuff users. The mean time in external fixation for all patients was 94 days (SD 20). Oral snuff users had the shortest time in external fixation (87 days (SD11)) compared to smokers (100 days (SD 25)) (p=0.03) and non-smokers/non-snuffers (93 days (SD 14)). The risk ratio for smokers developing complications was 6.1 (95% CI: 1.2-36.4) compared with oral snuff users. INTERPRETATION: Our findings indicate that the use of oral snuff does not delay bone healing or increase the risk of postoperative complications, which cigarette smoking does, in patients operated on by the hemicallotasis technique.