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To address this limitation, we conducted an Individual Participant Data (IPD) meta-analysis using data from three large cohorts: the Osteoarthritis Initiative (OAI), the Multicenter Osteoarthritis Study (MOST), and the Cohort Hip and Cohort Knee (CHECK) study. Participants from 16 centers in the USA and Netherlands were categorized as current, former, or never smokers. We assessed six outcomes, three related to structural changes over 4\u20135\u00a0years of follow-up, and three related to changes in KOA symptoms over 2\u20132.5\u00a0years, 5\u00a0years, and 7\u20138\u00a0years of follow-up. First, the incidence of radiographic KOA was evaluated in 10,072 knees, defined as having a Kellgren-Lawrence grade\u2009\u2265\u20092 (\u2018radiographic KOA\u2019) at follow-up but not at baseline. Second, the progression of radiographic KOA was evaluated in 5274 knees, defined as an increase in Kellgren\u2013Lawrence grade between baseline and follow-up in knees that had radiographic KOA at baseline. Third, the incidence of symptomatic KOA was evaluated in 12,910 knees, defined as having radiographic KOA in addition to symptoms at follow-up but not at baseline. Fourth, fifth, and sixth, we investigated changes between baseline and all follow-ups in scores for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales of pain, disability, and stiffness (in 2640 knees). There were no differences between smoking groups in any of these six outcomes. Our study, leveraging data from three large cohorts and the advantages of IPD, finds no evidence that smoking offers any protection against KOA, refuting the notion that smoking may benefit joint health.<\/jats:p>","DOI":"10.1038\/s41598-024-80345-x","type":"journal-article","created":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T20:08:16Z","timestamp":1732306096000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Association of smoking with knee osteoarthritis structural defects and symptoms: an individual participant data meta-analysis"],"prefix":"10.1038","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2982-4591","authenticated-orcid":false,"given":"Zubeyir","family":"Salis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9176-1574","authenticated-orcid":false,"given":"Amanda","family":"Sainsbury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,22]]},"reference":[{"key":"80345_CR1","unstructured":"United States Public Health Service Office of the Surgeon G, National Center for Chronic Disease P, Health Promotion Office on S, et al. 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