Paninigarilyo at Paghilom ng Musculoskeletal Impormasyon

Ano ito

Ang paninigarilyo at iba pang anyo ng tabako at nicotine ay nakakaapekto sa kung gaano kabilis gumaling ang iyong katawan pagkatapos ng operasyon sa buto, tendon, at joint. Mahalaga ito para sa maraming operasyong orthopaedic, kabilang ang joint replacements, rotator cuff repairs, ligament reconstructions, fracture fixation, at spinal fusion surgery. Mahalaga rin ito para sa mga heated tobacco products at smokeless tobacco, gaya ng chewing tobacco, dahil mayroon itong mga katulad na panganib sa mga sigarilyo.

Ang koneksyon ay nagmumula sa nicotine, ang nakaka-addict na kemikal sa tabako. Ang pananaliksik sa mga hayop at mga laboratory study ay nagpapakita na ang nicotine ay nakakaapekto sa paggaling ng buto sa paraang dose-dependent, ibig sabihin, habang mas mataas ang iyong exposure, mas malakas ang epekto nito [1]. Maaari ring pabagalin ng nicotine ang paglaki ng buto at gawing mas mahirap ang pagkapit ng implant sa iyong buto [1].

Ang mga epektong ito ay lumalabas din sa mga totoong operasyon. Iniugnay ng mga pag-aaral ang paninigarilyo at paggamit ng nicotine sa mas mataas na rate ng mga impeksyon sa sugat, pagkasira ng sugat, butong hindi gumagaling, at ang pangangailangan para sa karagdagang operasyon [2, 3, 4]. Pagkatapos ng ilang joint replacements at tendon repairs, ang mga naninigarilyo ay may tendensiyang makaranas ng mas matinding sakit at mas mahinang function kumpara sa mga taong hindi kailanman nanigarilyo [5, 6, 7].

Ang mabuting balita ay ito ay isang panganib na maaari mong baguhin. Tinatawag ito ng mga doktor na modifiable risk factor, ibig sabihin, isang bagay na maaari mong gawan ng aksyon bago ang operasyon [8, 9]. Ang paghinto sa paninigarilyo nang matagal bago ang iyong operasyon ay nagbibigay ng oras sa iyong katawan upang makabawi. Isang pag-aaral ang nakatuklas na ang mga taong huminto nang higit sa 6 na buwan bago ang rotator cuff repair ay walang nakitang pagtaas sa impeksyon o revision surgery kumpara sa mga taong hindi kailanman nanigarilyo [10]. Magtatanong ang iyong doktor tungkol sa lahat ng anyo ng paggamit ng tabako at nicotine bilang bahagi ng pagpaplano ng iyong operasyon, upang maaari kang magsalita nang tapat tungkol dito at gumawa ng plano nang magkasama.

Gumagana ba ito?

Ang tapat na sagot ay nag-iiba-iba ang mga resulta, at mas matibay ang ebidensya para sa ilang operasyon kaysa sa iba. Pagkatapos ng knee replacement, ang mga taong gumagamit ng smokeless tobacco ay may tendensiyang magkaroon ng mas malalang resulta kaysa sa mga taong hindi gumagamit nito [1]. Pagkatapos ng ligament reconstruction sa tuhod, ang mga non-smoker ay mas malamang na magkaroon ng mas mabuting function kaysa sa mga smoker [2]. Para sa rotator cuff repair, ang mga taong gumagamit ng heated tobacco ay may mas malalang paggaling kaysa sa mga taong hindi kailanman nanigarilyo [3].

Ang nicotine mismo ay tila bahagi ng problema, hindi lamang ang tobacco. Iniugnay ng pananaliksik ang nicotine dependence mula sa mga pinagkukunan maliban sa tobacco sa mas maraming wound breakdown, mga impeksyon, at malalang impeksyon pagkatapos ng shoulder replacement [4]. Iniugnay din ito sa pagluwag at pagkakaroon ng impeksyon ng mga implant sa loob ng 2 taon [4], at sa mas maraming follow-up procedure pagkatapos ng keyhole rotator cuff repair [5]. Ang paggamit ng cannabis ay iniugnay din sa mas maraming komplikasyon pagkatapos ng upper limb fracture surgery [6].

Hindi lahat ng natuklasan ay tumuturo sa iisang direksyon. Pagkatapos ng cartilage restoration surgery sa bukung-bukong (ankle), isang pag-aaral ang nakakita ng walang tunay na pagkakaiba sa activity levels sa pagitan ng mga smoker at non-smoker [7]. At para sa spinal fusion, ang mga mas bagong surgical technique at biologic augmentation, na nangangahulugang pagdaragdag ng mga materyales na naghihikayat ng paggaling, ay maaaring magbawas sa ilan sa mga pinsalang dulot ng paninigarilyo [8].

May mga puwang sa ating kaalaman. Marami sa pananaliksik na ito ang nagkukumpara ng mga grupo ng tao pagkatapos ng pangyayari sa halip na magsagawa ng mga maingat na trial kung saan direktang sinusubok ang pagtigil. Kaya mahirap sabihin nang eksakto kung gaano kalaking benepisyo ang hatid ng pagtigil para sa anumang partikular na operasyon. Ang sinusuportahan ng ebidensya ay ang pangkalahatang prinsipyo na tinalakay kanina: ang pagtigil nang matagal bago ang operasyon ay nagpapababa ng iyong panganib, at isang pag-aaral ang nakakita ng walang nakikitang pagtaas sa impeksyon o revision surgery sa mga taong tumigil nang higit sa 6 na buwan bago ang rotator cuff repair [9].

Maaaring talakayin ng iyong doktor kung ano ang kahulugan nito para sa iyong partikular na operasyon, at kung ang pagtigil o pagbabawas bago ang operasyon ay makakatulong sa iyong kaso.

Ano ang mga panganib?

Ang mga panganib ay nakadepende sa iyong operasyon, ngunit sumusunod ang mga ito sa isang pattern. Ang mga pinakakaraniwang problema ay nakakaapekto sa kung paano gumagaling ang iyong sugat. Ang paninigarilyo at paggamit ng nicotine ay naiugnay sa pagkasira ng sugat, mga impeksyon sa sugat, at malalang impeksyon pagkatapos ng operasyon [1, 2, 3]. Pagkatapos ng operasyon sa fracture sa bukung-bukong (ankle), ang paninigarilyo ay isang makabuluhang risk factor para sa impeksyon sa mismong sugat [3].

Mahalaga ang nicotine kahit walang tabako. Ang mga taong dependent sa nicotine mula sa mga pinagkukunan maliban sa tabako ay may mas mataas na rate ng pagkasira ng sugat, impeksyon, at sepsis, na isang malalang impeksyon sa buong katawan, sa loob ng 90 araw pagkatapos ng shoulder replacement [2]. Ang kanilang mga implant ay mas malamang ding lumuwag o magkaroon ng impeksyon sa loob ng 2 taon [2].

Ang ilang panganib ay lumalabas nang huli sa halip na agad-agad. Pagkatapos ng shoulder replacement, ang mga kasalukuyang naninigarilyo ay maaaring magkaroon ng mas mahinang function kaysa sa mga dating naninigarilyo at mga taong hindi kailanman nanigarilyo, kahit na ang kanilang mga rate ng komplikasyon at revision surgery ay magkakatulad [4]. Ang paninigarilyo ay naiugnay din sa mas maraming sakit at mas mahinang function sa midterm follow-up pagkatapos ng cartilage restoration surgery sa bukung-bukong [5]. Para sa ligament reconstruction sa tuhod, ang smokeless tobacco ay naiugnay sa mas maraming komplikasyon at revision surgery [6].

Ang paghilom ng buto mismo ay maaaring maapektuhan. Bago ang operasyon upang ayusin ang nabaling buto sa itaas na bahagi ng braso (upper arm bone), ang nicotine dependence ay naiugnay sa 60-110% pagtaas ng panganib ng mga komplikasyon, kabilang ang impeksyon, pagkasira ng sugat, buto na hindi gumagaling, at ang pangangailangan para sa karagdagang operasyon [1]. Ang paggamit ng cannabis ay naiugnay din sa mas maraming komplikasyon pagkatapos ng operasyon sa fracture sa upper limb [7].

Hindi lahat ng operasyon ay may parehong panganib. Natuklasan ng isang pag-aaral na ang paninigarilyo ng sigarilyo ay hindi naiugnay sa mas mahinang bone fusion pagkatapos ng isang uri ng spinal fusion na isinagawa gamit ang isang standardised technique [8]. At ang mga taong huminto nang higit sa 6 na buwan bago ang rotator cuff repair ay walang nakitang pagtaas sa impeksyon o revision surgery kumpara sa mga taong hindi kailanman nanigarilyo [9].

Maaaring talakayin ng iyong doktor kung alin sa mga panganib na ito ang naaangkop sa iyong operasyon, at kung ano ang maaari mong gawin upang mabawasan ang mga ito.

Tama ba ito para sa iyo?

Kung ikaw ay naninigarilyo o gumagamit ng anumang anyo ng tabako o nicotine, mahalaga ang paksang ito para sa iyong operasyon. Nalalapat ito naninigarilyo ka man ng sigarilyo o gumagamit ng heated tobacco o chewing tobacco. Nalalapat din ito kung gumagamit ka ng nicotine mula sa ibang pinagmulan, gaya ng mga replacement product, dahil ang nicotine lamang ay nakakaapekto na sa paggaling.

Mayroong isang praktikal na punto na dapat malaman. Kung ikaw ay kasalukuyan o kamakailang naninigarilyo at nagpaplano ng shoulder replacement, maaaring irekomenda ng iyong doktor na manatili sa ospital nang hindi bababa sa 2 gabi pagkatapos ng iyong operasyon, kahit na ang operasyon ay dapat sana ay isang day procedure [1]. Binibigyan nito ang iyong care team ng oras upang bantayan ang iyong sugat at pamahalaan ang anumang maagang problema.

Ang desisyon kung dapat mo bang baguhin ang iyong mga plano sa paligid ng operasyon ay dapat gawin kasama ang iyong doktor. Ang paghinto o pagbabawas bago ang iyong operasyon ay isang bagay na maaari mong gawin, at tutulungan ka ng iyong doktor na planuhin ito. Nakasaad sa seksyon ng mga panganib (risks) sa itaas kung ano ang maaaring magkamali kung maapektuhan ang paggaling, at kung aling mga operasyon ang may mas mataas na panganib kaysa sa iba.

Kung hindi ka pa kailanman nanigarilyo at hindi gumagamit ng nicotine, malabong malapat sa iyo ang mga pangkalahatang panganib na inilarawan dito. Itatanong pa rin ng iyong doktor ang tungkol sa paggamit ng tabako at nicotine bilang bahagi ng rutinang pagpaplano, upang magawa ang mga tamang hakbang para sa iyong operasyon.

Ang pinaka-importanteng punto

Kung ikaw ay naninigarilyo o gumagamit ng nicotine, makabubuting itigil ito o bawasan nang husto bago ang iyong operasyon. Ang paggaling pagkatapos ng operasyon sa buto, tendon, at joint ay karaniwang mas mabuti kung walang tabako o nicotine, at ang pagtigil ay isang risk na maaari mong kontrolin mismo. Ang makatotohanang inaasahan ay mas mababang pagkakataon ng mga problema sa sugat, impeksyon, at karagdagang operasyon, bagaman nag-iiba ang mga resulta depende sa operasyon at mas matibay ang ebidensya para sa ilan kaysa sa iba. Ang pinaka-importanteng babala: ang nicotine mismo, hindi lamang ang tabako, ay nakaaapekto sa paggaling, kaya ang mga replacement product at iba pang non-tobacco source ay kabilang pa rin at dapat banggitin sa iyong doktor.

Mga Sanggunian

[1] Ang epekto ng non-tobacco nicotine sa paghilom ng buto: isang systematic review at aplikasyon sa total joint arthroplasty. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06733-3

[2] Ang epekto ng nicotine dependence sa mga postoperative complication pagkatapos ng humeral shaft fracture repair. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100732

[3] Nontobacco Nicotine Dependence at mga Rate ng Periprosthetic Joint Infection at Iba Pang Postoperative Complication sa Shoulder Arthroplasty: Isang Retrospective Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00706

[4] Adverse effect ng paninigarilyo sa surgical site infection pagkatapos ng ankle at calcaneal fracture fixation: isang meta-analysis. EFORT Open Reviews. 2024. DOI: 10.1530/EOR-23-0139

[5] Ang epekto ng paninigarilyo sa mga outcome ng reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.07.052

[6] Ang paninigarilyo ay nauugnay sa inferior postoperative outcomes pagkatapos ng autologous osteochondral transplantation para sa mga osteochondral lesion ng talus: isang minimum 5-year clinical follow-up study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06428-1

[7] Ang epekto ng paninigarilyo sa functional outcomes at implant survival ng anatomical total shoulder arthroplasty. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0202.r1

[8] Impluwensya ng paninigarilyo sa shoulder arthroplasty outcomes: Isang meta-analysis ng mga postoperative complication. Shoulder & Elbow. 2025. DOI: 10.1177/17585732251327368

[9] Editorial Commentary

[10] Mahalaga ba ang timing? Ang epekto ng preoperative smoking cessation sa panganib ng impeksyon o revision pagkatapos ng rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.03.007

[11] Ang Paggamit ng Smokeless Tobacco ay Nauugnay sa Mas Masamang Outcomes Pagkatapos ng Total Knee Arthroplasty. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.01.035

[12] Tobacco's toll: Magkakatulad na anterior cruciate ligament graft failure rates at inferior functional outcomes sa mga naninigarilyo kumpara sa mga hindi naninigarilyo: Isang systematic review at meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70146

[13] Ang mga Heated Tobacco Product ay May mga Detrimental Effect sa Rotator Cuff Healing, Katulad ng mga Conventional Cigarette. Journal of Bone and Joint Surgery. 2024. DOI: 10.2106/jbjs.23.00804

[14] Ang Nontobacco Nicotine Dependence ay Nauugnay sa mga Perioperative Complication at Paulit-ulit na Operasyon Pagkatapos ng Arthroscopic Rotator Cuff Repair. Arthroscopy. 2026. DOI: 10.1002/arj.70189

[15] Ang paggamit ng cannabis at nicotine ay independiyenteng nauugnay sa mga adverse surgical, medical, at psychosocial outcome pagkatapos ng upper extremity fracture fixation. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-025-06635-w

[16] Editor’s Spotlight/Take 5: Ang Paninigarilyo ng Sigarilyo ay Hindi Nauugnay sa Mas Mababang Odds ng Radiographic Fusion Pagkatapos ng Combined TLIF at Posterolateral Lumbar (270°) Arthrodesis: Isang CT-based Retrospective Cohort Evaluation. Clinical Orthopaedics & Related Research. 2026. DOI: 10.1097/corr.0000000000003999

[17] Poster 132: Ang Paggamit ng Smokeless Tobacco ay Nauugnay sa Pagtaas ng Perioperative Complications at Revision Surgery Pagkatapos ng Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00229

[18] Ang Paninigarilyo ng Sigarilyo ay Hindi Nauugnay sa Mas Mababang Odds ng Radiographic Fusion Pagkatapos ng Combined TLIF at Posterolateral Lumbar (270°) Arthrodesis: Isang CT-based Retrospective Cohort Evaluation. Clinical Orthopaedics & Related Research. 2026. DOI: 10.1097/corr.0000000000003844

[19] Ang paninigarilyo ay isang independent risk factor para sa mga complication sa outpatient total shoulder arthroplasty. JSES International. 2023. DOI: 10.1016/j.jseint.2023.07.009

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Contemporary techniques and biologic augmentation may mitigate the adverse effects of smoking on radiographic fusion after combined TLIF and posterolateral lumbar arthrodesis [1].
Pack-years and duration of cessation serve as independent predictors of tendon healing after arthroscopic rotator cuff repair [2].
Surgeons should consider asking all patients with scaphoid fractures if they use smokeless tobacco or smoke to identify patients at risk for nonunions [3].
Active smokers are at an increased risk of both medical and surgical complications following elective knee or hip arthroplasty [4].
Heated tobacco users have worse clinical outcomes with respect to rotator cuff healing than nonsmokers [5].
Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol for total knee arthroplasty [13].
Smokeless tobacco use is associated with increased perioperative complications and revision surgery after anterior cruciate ligament reconstruction [16, 17].
Static scintigrams obtained in the early stages following tibial fracture showed 'cold spots' in 10 per cent of cases [23].
'Cold spots' on static scintigrams obtained in the early stages following tibial fracture did not bear any definite relationship to the normal progression of union [23].

How It Works

Contemporary techniques and biologic augmentation may mitigate the adverse effects of smoking in combined TLIF and posterolateral lumbar arthrodesis [1].
Tobacco use is a patient factor that influences lesser tuberosity osteotomy healing in stemmed and stemless anatomic shoulder arthroplasty [6].
Smoking is associated with a higher risk for complications than smokeless tobacco use following total knee arthroplasty [7].
Smoking is associated with higher residual pain and poorer functional outcomes at midterm follow-up after autologous osteochondral transplantation for osteochondral lesions of the talus [8].
Cessation of smoking is highly advised for meniscus repair performed in the presence of concurrent ligamentous injury [9].
Smoking is a modifiable risk factor that should be addressed to improve outcomes and reduce costs associated with complications in patients undergoing shoulder arthroplasty [10].
Smokeless tobacco use is associated with higher rates of medical- and joint-related complications following primary total hip arthroplasty [11].
Cigarette smoking was not associated with impaired radiographic fusion after TLIF with adjunctive posterolateral arthrodesis performed using a standardized technique [12].
Heated tobacco use has a similar deleterious effect on rotator cuff repair healing as cigarette smoking [14].
Nicotine has a dose-dependent effect on bone healing, bone growth, and implant integration [18].

What the Evidence Shows

Spine

Shoulder

Smoking is a modifiable risk factor that should be addressed to improve outcomes and reduce the costs associated with complications and joint replacement in patients undergoing shoulder arthroplasty [10].
Current smokers may have poorer functional outcomes after reverse total shoulder arthroplasty compared to former smokers and nonsmokers [15].
The incidence of complications and revision surgery after reverse total shoulder arthroplasty does not differ significantly between current smokers, former smokers, and nonsmokers [15].
Current smokers and former smokers who quit smoking within 6 months of rotator cuff repair are at an elevated risk of postoperative infection and revision surgery at 90 days, 1 year, and 2 years postoperatively compared with never smokers [22].

Knee

Smokeless tobacco use is associated with worse outcomes following total knee arthroplasty [7].
Smoking is associated with higher risk for complications than smokeless tobacco use following total knee arthroplasty [7].
Smoking within 30 days of total knee arthroplasty was associated with greater postoperative pain and lower odds of achieving an acceptable pain state compared to former and never-smokers [20].
Non-smokers were significantly more likely to achieve superior functional outcomes following ACL reconstruction [21].
Meniscus repair performed in the presence of concurrent ligamentous injury requires reduction of factors that may contribute to failure, and cessation of smoking is highly advised [9].

Hip

Foot and Ankle

There are no significant differences in activity levels based on Tegner scores between smokers and non-smokers after autologous osteochondral transplantation for osteochondral lesions of the talus [8].

Hand

Surgeons should consider asking all patients with scaphoid fractures if they use smokeless tobacco or smoke to further identify patients at risk for nonunions [3].

General and Nicotine

Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol [13].

Practical Considerations

Preoperative Screening and Risk Assessment

Surgeons should ask all patients with scaphoid fractures about smokeless tobacco or smoking use and add this to the intake history to identify patients at risk for nonunions [3].
Specific forms of tobacco use should be considered in preoperative screening for patients undergoing anterior cruciate ligament reconstruction [16, 17].

Arthroplasty and Joint Replacement

Current smokers may have poorer functional outcomes after reverse total shoulder arthroplasty compared to former smokers and nonsmokers, despite no significant differences in the incidence of complications and revision surgery [15].
Current or recent smokers may benefit from an inpatient setting of minimum 2 nights for outpatient total shoulder arthroplasty [19].

Spine and Fusion

Contemporary techniques and biologic augmentation may mitigate the adverse effects of smoking in the setting of combined TLIF and posterolateral lumbar arthrodesis [1].

Soft Tissue and Ligament Healing

Heated tobacco users have worse clinical outcomes with respect to rotator cuff healing than nonsmokers, similar to conventional cigarette smokers [5].
Cessation of smoking is highly advised for meniscus allograft transplantation and meniscus repair performed in the presence of concurrent ligamentous injury to reduce factors that may contribute to failure [9].

Bone and Cartilage Healing

Smoking is associated with higher residual pain and poorer functional outcomes at midterm follow-up after autologous osteochondral transplantation for osteochondral lesions of the talus, despite no significant differences in activity levels based on Tegner scores [8].

Key Evidence

[L3] Contemporary techniques and biologic augmentation may mitigate the adverse effects of smoking in this setting. [1] (10.1097/corr.0000000000003999)
[L3] Pack-years and duration of cessation serve as independent predictors of tendon healing. [2] (10.1177/03635465261422620)
[L3] Surgeons should consider asking all patients with scaphoid fractures if they use smokeless tobacco or smoke and consider adding this to the patient's intake history to further identify patients at risk for nonunions. [3] (10.5435/jaaos-d-23-00188)
[L1] The literature reveals that active smokers are at an increased risk of both medical and surgical complications. [4] (10.1016/j.arth.2024.10.035)
[L3] Heated tobacco users, like conventional cigarette smokers, have worse clinical outcomes with respect to rotator cuff healing than nonsmokers. [5] (10.2106/jbjs.23.00804)
[L3] In addition to the surgical technique, patient factors that influence tuberosity healing include a greater BMI and tobacco use. [6] (10.3390/jcm12030834)
[L3] However, smoking is associated with higher risk for complications than smokeless tobacco use. [7] (10.1016/j.arth.2023.01.035)
[L3] However, smoking is associated with higher residual pain and poorer functional outcomes at midterm follow-up, despite no significant differences in activity levels based on Tegner scores. [8] (10.1186/s13018-025-06428-1)
[L2] Nevertheless, MAT and meniscus repair performed in the presence of concurrent ligamentous injury require reduction of factors that may contribute to failure, and cessation of smoking is highly advised. [9] (10.1530/eor-24-0097)
[L1] Smoking is a modifiable risk factor that should be addressed to improve outcomes and reduce the costs associated with complications and joint replacement in patients undergoing shoulder arthroplasty. [10] (10.1177/17585732251327368)
[L3] Smokeless tobacco use is associated with higher rates of medical- and joint-related complications following primary THA. [11] (10.1016/j.arth.2023.05.041)
[L2] Cigarette smoking was not associated with impaired radiographic fusion after TLIF with adjunctive posterolateral arthrodesis performed using a standardized technique. [12] (10.1097/corr.0000000000003844)
[L3] Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol. [13] (10.5435/jaaos-d-23-01053)
[L4] This novel study shows that heated tobacco use has a similar deleterious effect on rotator cuff repair healing as cigarette smoking. [14] (10.2106/jbjs.24.00192)
[L3] Current smokers may have poorer functional outcomes after rTSA compared to former smokers and nonsmokers, despite the incidence of complications and revision surgery not differing significantly between cohorts. [15] (10.1016/j.jse.2024.07.052)
[L3] These findings highlight the importance of considering specific forms of tobacco use in preoperative screening for patients undergoing ACLR. [16] (10.1177/2325967125s00229)
[L3] These findings highlight the importance of considering specific forms of tobacco use in preoperative screening for patients undergoing ACLR. [17] (10.1177/03635465241303487)
[L2] Nicotine has a dose-dependent effect on bone healing, bone growth, and implant integration, as demonstrated in various animal and in vitro studies. [18] (10.1186/s13018-026-06733-3)
[L3] Current or recent smokers may benefit from an inpatient setting of minimum 2 nights. [19] (10.1016/j.jseint.2023.07.009)
[L3] Smoking within 30 days of TKA was associated with greater postoperative pain and lower odds of achieving an acceptable pain state compared to former and never-smokers. [20] (10.1016/j.arth.2026.04.018)
[L1] Nonetheless, non-smokers were significantly more likely to achieve superior functional outcomes following ACL reconstruction. [21] (10.1002/ksa.70146)
[L3] Current smokers and former smokers who quit smoking within 6 months of rotator cuff repair are at an elevated risk of postoperative infection and revision surgery at 90 days, 1 year, and 2 years postoperatively compared with never smokers. [22] (10.1016/j.jse.2023.03.007)
[L3] Static scintigrams obtained in the early stages following injury showed 'cold spots' in 10 per cent of cases, but these did not bear any definite relationship to the normal progression of union. [23] (10.1016/s0020-1383(86)80005-5)

References

[1] Editor’s Spotlight/Take 5: Cigarette Smoking Was Not Associated With Lower Odds of Radiographic Fusion After Combined TLIF and Posterolateral Lumbar (270°) Arthrodesis: A CT-based Retrospective Cohort Evaluation. Clinical Orthopaedics & Related Research. 2026. DOI: 10.1097/corr.0000000000003999

[2] Duration of Smoking Cessation Needed to Achieve Retear Rates Comparable to Those of Nonsmokers After Arthroscopic Rotator Cuff Repair. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261422620

[3] The Snuffbox: The Effect of Smokeless Tobacco Use on Scaphoid Fracture Healing. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00188

[4] Should Smoking Cessation Be Recommended and Required for Patients Undergoing Elective Knee or Hip Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.10.035

[5] Heated Tobacco Products Have Detrimental Effects on Rotator Cuff Healing, Similar to Conventional Cigarettes. Journal of Bone and Joint Surgery. 2024. DOI: 10.2106/jbjs.23.00804

[6] Lesser Tuberosity Osteotomy Healing in Stemmed and Stemless Anatomic Shoulder Arthroplasty Is Higher with a Tensionable Construct and Affected by Body Mass Index and Tobacco Use. Journal of Clinical Medicine. 2023. DOI: 10.3390/jcm12030834

[7] Smokeless Tobacco Use is Associated With Worse Outcomes Following Total Knee Arthroplasty. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.01.035

[8] Smoking is associated with inferior postoperative outcomes after autologous osteochondral transplantation for osteochondral lesions of the talus: a minimum 5-year clinical follow-up study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06428-1

[9] The impact of smoking on meniscus surgery: a systematic review. EFORT Open Reviews. 2025. DOI: 10.1530/eor-24-0097

[10] Influence of smoking on shoulder arthroplasty outcomes: A meta-analysis of postoperative complications. Shoulder & Elbow. 2025. DOI: 10.1177/17585732251327368

[11] Smokeless Tobacco Use is Associated With Worse Medical and Surgical Outcomes Following Total Hip Arthroplasty. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.05.041

[12] Cigarette Smoking Was Not Associated With Lower Odds of Radiographic Fusion After Combined TLIF and Posterolateral Lumbar (270°) Arthrodesis: A CT-based Retrospective Cohort Evaluation. Clinical Orthopaedics & Related Research. 2026. DOI: 10.1097/corr.0000000000003844

[13] Non-Tobacco Nicotine Dependence and Rates of Postoperative Complications in Total Knee Arthroplasty: A Propensity-Matched Comparison. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-01053

[14] All Forms of Tobacco Products Adversely Affect Rotator Cuff Healing. Journal of Bone and Joint Surgery. 2024. DOI: 10.2106/jbjs.24.00192

[15] The effect of smoking on outcomes of reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.07.052

[16] Poster 132: Smokeless Tobacco Use is Associated with Increased Perioperative Complications and Revision Surgery After Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00229

[17] Association of Smokeless Tobacco Use With Perioperative Complications and Revision Surgery After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241303487

[18] The effect of non-tobacco nicotine on bone healing: a systematic review and application to total joint arthroplasty. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06733-3

[19] Smoking is an independent risk factor for complications in outpatient total shoulder arthroplasty. JSES International. 2023. DOI: 10.1016/j.jseint.2023.07.009

[20] Impact of Smoking Status on Early Outcomes and Healthcare Utilization Following Primary Total Knee Arthroplasty: A Retrospective Cohort Study. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.04.018

[21] Tobacco's toll: Comparable anterior cruciate ligament graft failure rates and inferior functional outcomes in smokers compared to non‐smokers: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70146

[22] Does timing matter? The effect of preoperative smoking cessation on the risk of infection or revision following rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.03.007

[23] Static and sequential dynamic scintigraphy of the tibia following fracture. Injury. 1986. DOI: 10.1016/s0020-1383(86)80005-5