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Tobacco use results in inferior outcomes after anatomic total shoulder arthroplasty

Walters, Jordan D., MDa; George, L. Watson II, MDb; Wan, Jim Y., PhDc; Brolin, Tyler J., MDa; Azar, Frederick M., MDa; Throckmorton, Thomas W., MDa

doi: 10.1097/BCO.0000000000000714

Background: This study examined the effect of tobacco use on outcomes of primary anatomic total shoulder arthroplasty (TSA).

Methods: A retrospective search identified 59 nonsmokers, 29 former smokers, and 14 current smokers with primary anatomic TSA and at least 2 yr of follow-up. At mean follow-up of 3 yr, patients were assessed with a visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores and range-of-motion testing.

Results: Smokers were significantly younger than nonsmokers or former smokers; there were no other statistically significant differences. VAS scores were significantly higher in current smokers and ASES scores were significantly lower. Complication rates were 36% in current smokers, 15% in nonsmokers, and 7% in former smokers (P = 0.05).

Conclusions: Current smokers had significantly worse pain and functional scores and more complications. Former smokers had results similar to nonsmokers, suggesting improved outcomes are possible in patients who quit smoking preoperatively.

aUniversity of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, Memphis, TN

bGreenville Health System, Clinical University, Department of Orthopaedic Surgery, Greenville, SC

cUniversity of Tennessee Health Science Center, Department of Preventive Medicine, Division of Biostatistics, Memphis, TN

Financial Disclosure: Dr. Azar discloses a financial relationship outside this work with 98point6, Iovera, Zimmer, and Elsevier. Dr. Throckmorton discloses a financial relationship outside this work with IP, Biomet, Zimmer, and Elsevier. The other authors have no disclosures. The authors report no conflicts of interest in regard to this work.

Correspondence to Thomas W. Throckmorton, MD, 1211 Union Avenue, Suite 510, Memphis TN 38104 Tel: +901-759-3270; fax: +901-759-3278; e-mail:

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