Aims We sought to compare functional outcomes and survival between non-smokers, former smokers, and current smokers who underwent anatomical total shoulder arthroplasty (aTSA) in a large cohort of patients. Methods A retrospective review of a prospectively collected shoulder arthroplasty database was performed between August 1991 and September 2020 to identify patients who underwent primary aTSA. Patients were excluded for preoperative diagnoses of fracture, infection, or oncological disease. Three cohorts were created based on smoking status: non-smokers, former smokers, and current smokers. Outcome scores (American Shoulder and Elbow Surgeons (ASES), Constant-Murley score, Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), University of California, Los Angeles activity scale (UCLA)), range of motion (external rotation (ER), forward elevation (FE), internal rotation, abduction), and shoulder strength (ER, FE) evaluated at two- to four-year follow-up were compared between cohorts. Evaluation of revision-free survival was performed using the Kaplan-Meier method to final follow-up. Results We included 428 primary aTSAs with a mean follow-up of 2.4 years (SD 0.6). Our cohort consisted of 251 non-smokers, 138 former smokers who quit a mean 21 years (SD 14) prior to surgery (25 pack-years (SD 22)), and 39 current smokers (23 pack-years (SD 20)). At two- to four-year follow-up, former smokers had less favourable SPADI, SST, and FE strength compared to non-smokers, and current smokers had less favourable SPADI, SST, ASES score, UCLA score, Constant-Murley score, FE, abduction, and ER strength compared to non-smokers. Non-smokers exhibited higher revision-free survival rates at two, five, eight, and ten years postoperatively compared to former smokers and current smokers, who had similar rates. Conclusion Our study suggests that smoking has a negative effect on aTSA functional outcomes that may persist even after quitting.

中文翻译：

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吸烟对解剖全肩关节置换术功能结局和植入物存活率的影响。


目的 我们试图比较在一大群患者中接受解剖全肩关节置换术 （aTSA） 的非吸烟者、既往吸烟者和当前吸烟者之间的功能结局和生存率。方法 在 1991 年 8 月至 2020 年 9 月期间对前瞻性收集的肩关节置换术数据库进行回顾性评价，以确定接受原发性 aTSA 的患者。患者因术前诊断骨折、感染或肿瘤疾病而被排除在外。根据吸烟状况创建了三个队列：非吸烟者、以前吸烟者和当前吸烟者。结果评分 （美国肩肘外科医生 （ASES）、Constant-Murley 评分、肩痛和残疾指数 （SPADI）、简单肩部试验 （SST）、加州大学洛杉矶分校活动量表 （UCLA））、运动范围 （外旋 （ER）、前升 （FE）、内旋、外展）和肩部力量 （ER， FE） 在队列之间进行比较。使用 Kaplan-Meier 方法进行无翻修生存期评估至最终随访。结果 我们纳入了 428 例原发性 aTSA，平均随访时间为 2.4 年 （SD 0.6）。我们的队列包括 251 名非吸烟者、138 名手术前平均戒烟 21 年 （SD 14） 的前吸烟者 （25 包年 （SD 22）） 和 39 名当前吸烟者 （23 包年 （SD 20））。在 2 至 4 年的随访中，与非吸烟者相比，既往吸烟者的 SPADI 、 SST 和 FE 强度较差，而当前吸烟者的 SPADI 、 SST、ASES 评分、 UCLA 评分、Constant-Murley 评分、 FE 、 外展和 ER 强度与非吸烟者相比。 与既往吸烟者和当前吸烟者相比，非吸烟者在术后 2 年、 5 年、8 年和 10 年表现出更高的无翻修生存率，后者的生存率相似。结论 我们的研究表明，吸烟对 aTSA 功能结果有负面影响，即使在戒烟后也可能持续存在。