The effect of smoking on outcomes of reverse total shoulder arthroplasty

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.

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.

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.

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.