We conducted a review of current literature to examine the effects of smoking and smoking cessation on shoulder arthroplasty surgery.
Methods
A literature search was performed using the search terms “shoulder arthroplasty AND [smoke OR smoking OR tobacco OR nicotine].” Studies included English-language clinical outcomes studies on anatomic total shoulder arthroplasty (TSA), reverse TSA, and partial shoulder arthroplasty with evidence levels 1 through 4. Descriptive statistics calculated in the included studies were used during the analysis. Categorical variables were reported as proportions, while continuous variables were reported as means with minimum to maximum absolute ranges.
Results
Twenty-four studies were included and analyzed. Following TSA, patients who quit smoking at least 1 month preoperatively had improved outcomes compared to current smokers. Current smokers had statistically significant higher pain scores or opioid use. Five studies found increased rates of revision surgery in smokers. Smokers were significantly (p < 0.05) more likely to have increased rates of surgical, wound, superficial, and deep surgical site complications.
Discussion
Former smokers had lower complication rates and visual analog scale scores when compared to current users. A period of four weeks or more of preoperative smoking cessation is recommended.
DayJSLauEOngKL, et al.Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg2010; 19: 1115–1120.
2.
KimSHWiseBLZhangY, et al.Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am2011; 93: 2249–2254.
3.
NorrisTRIannottiJP. Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. J Shoulder Elbow Surg2002; 11: 130–135.
4.
CowlingPDHollandPKottamL, et al.Risk factors associated with intraoperative complications in primary shoulder arthroplasty. Acta Orthop2017; 88: 587–591.
National Center for Chronic Disease P, Health Promotion Office on S and Health. Reports of the Surgeon General. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention (US), 2014.
7.
McConaghyKKunzeKNMurrayT, et al.Smoking cessation initiatives in total joint arthroplasty: an evidence-based review. JBJS Rev 2021; 9: e21.00009. DOI: 10.2106/jbjs.Rvw.21.00009.
8.
MøllerAMPedersenTVillebroN, et al.Effect of smoking on early complications after elective orthopaedic surgery. J Bone Joint Surg Br2003; 85: 178–181.
9.
MøllerAMVillebroNPedersenT, et al.Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet2002; 359: 114–117.
10.
AlthoffADReevesRATravenSA, et al.Smoking is associated with increased surgical complications following total shoulder arthroplasty: an analysis of 14,465 patients. J Shoulder Elbow Surg2020; 29: 491–496.
11.
BestMJHarrisABBansalA, et al.Predictors of long-term opioid use after elective primary total shoulder arthroplasty. Orthopedics2021; 44: 58–63.
12.
KoladeOOGhoshNFernandezL, et al.Study of variations in inpatient opioid consumption after total shoulder arthroplasty: influence of patient- and surgeon-related factors. J Shoulder Elbow Surg2020; 29: 508–515.
13.
WaltersJDGeorgeLW2ndWalshRN, et al.The effect of current and former tobacco use on outcomes after primary reverse total shoulder arthroplasty. J Shoulder Elbow Surg2020; 29: 244–251.
14.
KhaziZMLuYPatelBH, et al.Risk factors for opioid use after total shoulder arthroplasty. J Shoulder Elbow Surg2020; 29: 235–243.
15.
WaltersJGeorgeLWanJ, et al.Tobacco use results in inferior outcomes after anatomic total shoulder arthroplasty. Curr Orthop Pract2018; 30: 1.
16.
WellsDBHoltAMSmithRA, et al.Tobacco use predicts a more difficult episode of care after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg2018; 27: 23–28.
17.
MartusiewiczAKhanAZChamberlainAM, et al.Outpatient narcotic consumption following total shoulder arthroplasty. JSES Int2020; 4: 100–104.
18.
FriedmanRJEichingerJSchochB, et al.Preoperative parameters that predict postoperative patient-reported outcome measures and range of motion with anatomic and reverse total shoulder arthroplasty. JSES Open Access2019; 3: 266–272.
19.
LeongNLSumnerSGowdA, et al.Risk factors and complications for revision shoulder arthroplasty. HSS J2020; 16: 9–14.
20.
SamuelsenBTWagnerERHoudekMT, et al.Primary reverse shoulder arthroplasty in patients aged 65 years or younger. J Shoulder Elbow Surg2017; 26: e13–e17.
21.
WernerBCBurrusMTBeghoI, et al.Early revision within 1 year after shoulder arthroplasty: patient factors and etiology. J Shoulder Elbow Surg2015; 24: e323–e330.
22.
SchwartzAMFarleyKXBodenSH, et al.The use of tobacco is a modifiable risk factor for poor outcomes and readmissions after shoulder arthroplasty. Bone Joint J2020; 102–b: 1549–1554.
23.
WagnerEHoudekMTGriffithT, et al.Glenoid bone-grafting in revision to a reverse total shoulder arthroplasty. J Bone Joint Surg Am2015; 97: 1653–1660.
24.
MatarRNShahNSVincentJC, et al.Factors that influence inpatient satisfaction after shoulder arthroplasty. J Shoulder Elbow Surg2021; 30: e165–e172.
25.
LevyJCAshukemMTFormainiNT. Factors predicting postoperative range of motion for anatomic total shoulder arthroplasty. J Shoulder Elbow Surg2016; 25: 55–60.
26.
PolceEMWolfsonTSSkallerudWK, et al.Establishing thresholds for achievement of clinically significant satisfaction at two years following shoulder arthroplasty: the patient acceptable symptomatic state. Semin Arthrop: JSES2021; 31: 159–170.
27.
RoachRYuSPhamH, et al.Microbial colonization of subscapularis tagging sutures in shoulder arthroplasty: a prospective, controlled study. J Shoulder Elbow Surg2019; 28: 1848–1853.
28.
HattaTWerthelJDWagnerER, et al.Effect of smoking on complications following primary shoulder arthroplasty. J Shoulder Elbow Surg2017; 26: –6.
29.
LeschingerTRaissPLoewM, et al.Total shoulder arthroplasty: risk factors for intraoperative and postoperative complications in patients with primary arthritis. J Shoulder Elbow Surg2017; 26: e71–e77.
30.
OttoRJViraniNALevyJC, et al.Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification. J Shoulder Elbow Surg2013; 22: 1514–1521.
31.
MorrisBJO’ConnorDPTorresD, et al.Risk factors for periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elbow Surg2015; 24: 161–166.
32.
SinghAPadillaMNybergEM, et al.Cement technique correlates with tuberosity healing in hemiarthroplasty for proximal humeral fracture. J Shoulder Elbow Surg2017; 26: 437–442.
33.
RingJShoaibAShariffR. Smoking cessation advice in limb reconstruction: an opportunity not to be missed. Injury2017; 48: 345–348.
34.
WongJLamDPAbrishamiA, et al.Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth2012; 59: 268–279.
35.
TønnesenHNielsenPRLauritzenJB, et al.Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth2009; 102: 297–306.
36.
MillsEEyawoOLockhartI, et al.Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med2011; 124: 144–154. e148.
HerseyPPrendergastDEdwardsA. Effects of cigarette smoking on the immune system. Follow-up studies in normal subjects after cessation of smoking. Med J Aust1983; 2: 425–429.
39.
MehtaHNazzalKSadikotRT. Cigarette smoking and innate immunity. Inflamm Res2008; 57: 497–503.
40.
KnuutinenAKokkonenNRisteliJ, et al.Smoking affects collagen synthesis and extracellular matrix turnover in human skin. Br J Dermatol2002; 146: 588–594.
41.
RampWKLenzLGGalvinRJ. Nicotine inhibits collagen synthesis and alkaline phosphatase activity, but stimulates DNA synthesis in osteoblast-like cells. Proc Soc Exp Biol Med1991; 197: 36–43.
42.
JorgensenLNKallehaveFChristensenE, et al.Less collagen production in smokers. Surgery1998; 123: 450–455.
43.
SrbinoskaMKavrakovskiZRafajlovskaV, et al.Determined and declared nicotine content in refill liquids for electronic cigarettes marketed in north Macedonia. Arh Hig Rada Toksikol2019; 70: 130–133.
