Tobacco use predicts worse pain after reverse shoulder arthroplasty
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Patients who used tobacco at the time of reverse total shoulder arthroplasty had increased patient-reported pain but no negative functional outcomes, according to published results.
Thomas W. Throckmorton, MD, and colleagues assessed preoperative and postoperative VAS pain scores, American Shoulder and Elbow Surgeon scores, strength, range of motion, complications, revisions and narcotic use for 186 patients who underwent primary reverse total shoulder arthroplasty. Researchers also analyzed radiographs for signs of loosening or mechanical failure. Researchers classified patients as nonsmokers (n=76), former smokers (n=89) or current smokers (n=21).
Compared with nonsmokers and former smokers, results showed smokers were significantly younger. Researchers found significant improvements in pain, ASES score, strength and forward flexion range of motion among all patients. However, VAS pain scores were higher among smokers vs. nonsmokers and former smokers, according to results. Besides differences in VAS pain scores, researchers noted no differences among the groups regarding any of the postoperative parameters.
“Tobacco use is a modifiable risk factor that affects outcomes after reverse total shoulder arthroplasty (RTSA). However, the negative effects of tobacco appear to be blunted in reverse arthroplasty compared to anatomic total shoulder replacement,” Throckmorton told Healio Orthopedics. “We think this is because the reverse replacement bypasses the need for a functional rotator cuff. Nevertheless, smokers reported worse pain following RTSA compared to their peers. Happily, former smokers did not have this negative effect, indicating that quitting smoking allows patients to attain outcomes similar to those that have never used tobacco.” – by Casey Tingle
Disclosure: Throckmorton reports no relevant financial disclosures.
Editor’s note: On Feb. 3, 2020, the headline and lede of this article were changed to more accurately reflect the author’s conclusions.
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April D. Armstrong, BSc(PT), MSc, MD, FRCSC
In this study of 186 patients, there was no correlation between tobacco use and inferior functional outcomes nor increased complication rates after primary reverse total shoulder arthroplasty. It is proposed that the reverse design bypasses the need for soft tissue healing of the rotator cuff and therefore, patients are less affected by the adverse effects of smoking. However, smokers did have elevated postoperative pain scores compared to nonsmokers or previous smokers. Clearly, preoperative smoking cessation programs should continue for the overall health benefits of our patients and optimized postoperative pain control. On the other hand, if patients’ attempts at smoking cessation have failed, then this early data suggests that patients undergoing a reverse implant may be at less risk for complications than those undergoing an anatomic replacement, which relies heavily on soft tissue healing.
Acting chair of the department of orthopedics and rehabilitation
Penn State Milton S. Hershey Medical Center
Hershey, Pennsylvania
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