The effect of smoking on outcomes of reverse total shoulder arthroplasty

Derek S Damrow; Timothy R Buchanan; Kevin A Hao; Isabella E Amador; Keegan M Hones; Trevor Simcox; Bradley S Schoch; Kevin W Farmer; Thomas W Wright; Tyler J LaMonica; Joseph J King; Jonathan O Wright

doi:10.1016/j.jse.2024.07.052

The effect of smoking on outcomes of reverse total shoulder arthroplasty

J Shoulder Elbow Surg. 2024 Sep 25:S1058-2746(24)00696-7. doi: 10.1016/j.jse.2024.07.052. Online ahead of print.

Affiliations

¹ Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
² College of Medicine, University of Florida, Gainesville, FL, USA.
³ Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
⁴ Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. Electronic address: wrightjo@ortho.ufl.edu.

PMID: 39332471
DOI: 10.1016/j.jse.2024.07.052

Abstract

Background: The effect of smoking status on clinical outcomes in reverse total shoulder arthroplasty (rTSA) has not been thoroughly characterized. We sought to compare pain and functional outcomes, complications, and revision-free survivorship between current smokers, former smokers, and nonsmokers undergoing primary rTSA.

Methods: We retrospectively reviewed a prospectively collected shoulder arthroplasty database from 2004-2020 to identify patients who underwent primary rTSA. Three cohorts were created based on smoking status: current smokers, former smokers, and nonsmokers. Outcome scores (Shoulder Pain and Disability Index [SPADI], Simple Shoulder Test [SST], American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA], and Constant), range of motion (external rotation, forward elevation, abduction, and internal rotation), and shoulder strength (external rotation and forward elevation) evaluated at 2-4-year follow-up were compared between cohorts. The incidence of complication and revision-free implant survivorship were evaluated.

Results: We included 676 primary rTSAs, including 38 current smokers (44 ± 47 pack-years), 84 former smokers who quit on average 20 ± 14 years (range: 0.5-57 years) prior to surgery (38 ± 32 pack-years), and 544 nonsmokers. At 2-4-year follow-up, current smokers had less favorable SPADI, SST, ASES scores, UCLA scores, and Constant scores compared to former smokers and nonsmokers. On multivariable analysis, current smokers had less favorable SPADI, SST, ASES score, UCLA score, and Constant score compared to nonsmokers. There were no significant differences between cohorts in complication rate and revision-free survivorship.

Conclusion: Our data showed that current smokers may have poorer functional outcomes after rTSA compared to former smokers and nonsmokers, despite the incidence of complications and revision surgery not differing significantly between cohorts.

Keywords: Tobacco use; implant retention; patient-reported outcome; range of motion; reverse shoulder arthroplasty; revision-free survivorship; smoker; strength.

Published by Elsevier Inc.