Effect of smoking on complications following primary shoulder arthroplasty.
BACKGROUND
The purpose of this study was to examine the effect of smoking on the incidence of complications after primary anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA).


METHODS
All patients who underwent primary TSA or RSA at our institution between 2002 and 2011 and had a minimum 2-year follow-up were included. Smoking status was assessed at the time of surgery. Current smokers, former smokers, and nonsmokers were compared for periprosthetic infection, fractures (intraoperative and postoperative), and loosening after surgery.


RESULTS
The cohort included 1834 shoulders in 1614 patients (814 in smokers and 1020 in nonsmokers). Complications occurred in 73 patients (75 shoulders; 44 in smokers and 31 in nonsmokers). There were 20 periprosthetic infections (16 in smokers and 4 in nonsmokers), 27 periprosthetic fractures (14 in smokers and 13 in nonsmokers), and 28 loosenings (14 in smokers and 14 in nonsmokers). Smokers had lower periprosthetic infection-free survival rates (95.3%-99.4% at 10 years; P = .001) and overall complication-free survival rates (78.4%-90.2%; P = .012) than nonsmokers. Multivariable analyses showed that both current and former smokers had significantly higher risk of periprosthetic infection in comparison with nonsmokers (hazard ratio [HR], 7.27 and 4.56, respectively). In addition, current smokers showed a higher risk of postoperative fractures than both former smokers (HR, 3.63) and nonsmokers (HR, 6.99).


CONCLUSIONS
This study demonstrates that smoking is a significant risk factor of complications after TSA and RSA. These findings emphasize the need for preoperative collaborative interventions, including smoking cessation programs.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Taku
T
Hatta
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Jean-David
JD
Werthel
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Eric R
ER
Wagner
Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Eiji
E
Itoi
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Scott P
SP
Steinmann
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Robert H
RH
Cofield
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: sperling.john@mayo.edu.
John W
JW
Sperling
D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000453:epidemiology*; D011475:Prosthesis Failure / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012785:Shoulder Joint / Q000601:surgery; D000072227:Shoulder Prosthesis; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome
Total shoulder arthroplasty; complications; periprosthetic fracture; periprosthetic infection; reverse shoulder arthroplasty; smoking