Table 3.
Measures of shoulder function.
| Level of evidence | Author(s) | Journal | Number of patients, mean age (years) | Type of arthroplasty | Pertinent findings |
|---|---|---|---|---|---|
| III | Walters et al 13 (2020) | Journal of Shoulder and Elbow Surgery | 186 (70) | Reverse TSA | Smokers did not significantly improve postoperatively for internal and external rotation (p = 0.31 and p = 0.83, respectively). Nonsmokers and former smokers had significant (p < 0.05) improvements postoperatively for all forward flexion and internal/external rotation. Nonsmokers had nonsignificant improvement in external rotation. |
| III | Polce et al 26 (2021) | Journal of Shoulder and Elbow Surgery | 204 (66) | Anatomic TSA & reverse TSA | A two-year follow-up, patient-reported outcomes survey found that smokers had lower rates of achieving the PASS than nonsmokers after anatomic TSA: PASS on ASES (OR, 0.5 [95% CI, 0.279–0.896], p = .022), PASS for Constant-Murley (OR, 0.48 [95% CI, 0.251–0.909], p = .027). The PASS for SANE in anatomic TSA was nonsignificant for smokers. The reverse TSA cohort had nonsignificant PASS score differences for smokers in the ASES, SANE, and Constant–Murley surveys. |
| III | Walters et al 15 (2018) | Current Orthopaedic Practice | 102 (66) | Anatomic TSA | No significant difference in smokers for ROM and SANE scores. The mean ASES score in smokers is significantly lower (62) than nonsmokers (79) and former smokers (84) (p = .0007), indicating worse postoperative shoulder function. |
| III | Wells et al 16 (2018) | Journal of Shoulder and Elbow Surgery | 163 (61) | Anatomic TSA | LOS was not significantly longer in smokers than former and nonsmokers (1.21 days vs. 0.95 vs. 1.07). |
| IV | Levy et al 25 (2016) | Journal of Shoulder and Elbow Surgery | 230 (70) | Anatomic TSA | Smokers did not have statistically different ROM postoperatively from nonsmokers (R, 0.078; p = .23). |
| III | Friedman et al 18 (2019) | Journal of Shoulder and Elbow Surgery | 2421 (NR) | Anatomic TSA & reverse TSA | Smoking had significant effects on reverse TSA scores postoperatively. It negatively influenced the following postoperative scores: internal rotation scores by 0.7 points (p = .002), ASES scores by 8.7 points (p = .001), Shoulder Function Score by 0.6 points (p = .033), SST score by 1.2 points (p = .001), and UCLA score by 1.6 points (p = .02). Tobacco use did not have significant effects on postoperative reverse TSA scores for abduction, forward flexion, and external rotation. Smoking did not have significant effects postoperatively for any anatomic TSA shoulder scores. |
ASES: American Shoulder and Elbow Surgeons Shoulder Score; LOS: length of stay; NR: not reported; PASS: Patient Acceptable Symptomatic State; ROM: range of motion; SANE: Single Assessment Numeric Evaluation; SST: Simple Shoulder Test; TSA: total shoulder arthroplasty; UCLA: University of California Los Angeles.