The role of smoking status on survivorship and clinical outcomes following total shoulder arthroplasty

Background

Smoking has been strongly associated with poor healing and worse outcomes following various joint arthroplasties, including worse functional measurements and increased complication rates. While smoking is associated with adverse events and complications in shoulder arthroplasty, the role of smoking in functional measurements and patient-reported outcomes (PROs) remains to be fully characterized.

Methods

Institutional electronic medical records were used to study patients who underwent primary anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) between 2009 and 2020 with at least 2 years of follow-up. Patients were called to obtain PROs. Patients were stratified into 3 cohorts, by tobacco smoking status: current, former, and never smokers.

Results

Among 498 patients who underwent TSA, 280 were aTSAs and 218 were rTSAs. Within aTSAs, 28 patients were classified as current, 99 as former, and 153 as never smokers. In rTSAs, 20 were current, 68 were former, and 130 were never smokers. Current smokers were younger at the time of surgery than former and never smokers in both aTSA (current: 58.8 ± 8.5; former: 63.9 ± 9.2; never: 62.8 ± 9.0 years; P = .031) and rTSA (current: 59.0 ± 6.8; former: 68.5 ± 7.2; never: 69.0 ± 9.0 years; P < .001). Furthermore, current smokers experienced lower 5-year implant survival in aTSA (current: 84.3%; former: 98.8%; never: 95.0%; P = .015) and rTSA (current: 82.4%; former: 94.5%; never: 94.1%; P = .004). No differences were found among the 3 cohorts for preoperative range of motion (ROM) and strength, or postoperative ROM and strength in the aTSA cohort. rTSA preoperative measurements demonstrated no differences in ROM and strength, and only postoperative forward elevation strength and external rotation strength were found to be different. PROs were found to be of similar magnitude for all patients in the aTSA and rTSA groups.

Conclusion

The findings of this study indicate that current smokers exhibited a higher likelihood of necessitating TSA at a younger age and had higher implant failure rates. However, functional measurements were only marginally affected by smoking status.