It’s becoming increasingly clear that orthopaedic patients who smoke have worse outcomes than those who don’t. The clinical effects of smoking on bone and wound healing have been well-studied, and include longer times to union, higher rates of nonunion, and higher rates of infection and wound complications.
 Cigarette smoke contains about 5,000 chemical agents and more than 60 carcinogens, toxins, and poisons such as arsenic, ammonia, methane, butane, and cadmium.   The most addictive substance known to man is nicotine!
Smokers may not realize the adverse impact of smoking in orthopaedic procedures.  Some of the highlighted effects of smoking include worse fracture healing, more unsuccessful reconstructive procedures, wound healing problems and higher infection rates.  Patients that smoke, have diabetes and are obese have extraordinary high complication rates with surgical treatment.  
Women are more vulnerable to nicotine addition, experience greater negative effects from smoking, and find it more difficult to quit than men. Although genetic factors make some individuals more susceptible to smoking than others, the following may also be contributing factors: multiple military deployments, menthol cigarettes, nocturnal body rhythms, and peer pressure.
Doctors have good reason to advise patients that they are not candidates for surgery; it won’t help them. Based on a study of more than 5,000 patients, smokers had more pain and showed the least improvement, regardless of the treatment (surgical or nonsurgical).
The goal is for the patient to be smoke-free for a minimum of 6 weeks.