吸烟与肌肉骨骼愈合资料

什么是吸烟对愈合的影响

吸烟影响的不只是您的肺和心脏。它还会减慢骨、关节、肌腱和韧带手术后身体的愈合。本页解释其原因，以及这对您的手术意味着什么。

尼古丁是烟草中令人成瘾的化学物质，它会使向愈合组织输送氧气和营养的小血管变窄。它对骨愈合、骨生长以及植入物与骨的融合具有剂量依赖性的影响 [1]。这意味着您的身体摄入的尼古丁越多，它对愈合的干扰就可能越大。骨骼需要稳定的血液供应才能重新长合，而植入物需要健康的骨骼才能牢固地嵌入。

这些影响体现在许多类型的手术中。吸烟者在择期髋关节或膝关节置换术后发生内科和外科并发症的风险更高 [2]。肩袖修复术后，加热型烟草制品对肌腱愈合的有害影响与香烟相似 [3]。无烟烟草与前交叉韧带（ACL）重建术后 [4, 5] 以及髋关节置换术后 [6] 更多的并发症有关。对于踝部和跟骨骨折手术，吸烟会增加伤口感染的风险 [7]。上臂骨折手术前存在尼古丁依赖，会使感染、伤口裂开、骨不连（骨折未能愈合）和再次手术等并发症的风险增加60-110% [8]。

好消息是，吸烟是一个可改变的风险因素 [9, 10]。这意味着这是您可以改变的。戒烟很重要。在肩袖修复术前超过6个月戒烟的既往吸烟者，与从不吸烟的人相比，感染或翻修手术的发生率没有可检测到的升高 [11]。医生可以在您的手术日期之前很早就与您讨论戒烟以及尼古丁替代疗法的选择。

它有效吗？

坦白地说，吸烟者的手术仍然可以取得效果，但证据显示效果往往较差。关于肩关节置换的研究发现，目前仍在吸烟的人术后功能可能比从不吸烟或已戒烟的人差 [12]。各组之间的并发症和翻修手术发生率相似 [12]。因此，植入物本身可能保持良好，但您肩部的感觉和活动可能达不到同样的水平。

不含烟草的尼古丁本身也有影响。关于肩关节置换的研究发现，来自吸烟以外来源的尼古丁依赖，与术后最初90天内更多的伤口裂开和感染有关，也与2年时更多的假体松动和关节感染有关 [13]。关节镜下肩袖修复术后，有尼古丁依赖的人在2年和5年时都需要更多的肩袖再修复手术，以及更多松解僵硬肩关节或清理关节的手术 [14]。

同样的规律也出现在其他地方。前交叉韧带重建术后，从不吸烟的人比吸烟者更有可能获得良好的膝关节功能 [15]。对于膝关节置换，吸烟似乎主要影响早期恢复阶段，而不仅仅是疼痛程度 [16]。对于骨折手术，尼古丁对骨愈合的影响取决于剂量，这一点已在动物和实验室研究中得到证实 [1]。建议外科医生询问每一位舟骨（腕部的一块小骨）骨折患者是否吸烟或使用无烟烟草，因为两者都会增加骨折不愈合的几率 [17]。

这些证据的强度各不相同。其中许多来自大型病历数据库，而不是将患者随机分组的试验。有些研究结果并不一致。一项研究发现，膝关节置换术后吸烟的并发症风险高于无烟烟草 [18]，这提示在手术前后没有哪种烟草制品是明确安全的。

这对您意味着什么很简单：在手术前戒烟能让您的身体获得良好愈合的最佳机会，而且戒得越早越好。

风险有哪些？

主要的风险前面已经介绍过：愈合变慢、伤口问题和感染。但有一些细节值得了解。

任何来源的尼古丁，而不仅仅是香烟，都会增加肩关节置换术后最初90天内伤口裂开、感染以及感染严重扩散的几率 [13]。它还会增加2年时植入物松动或感染的几率 [13]。这包括来自尼古丁袋、尼古丁口香糖或其他完全不含烟草的产品中的尼古丁。

有些风险取决于手术部位。吸烟会增加踝部和跟骨骨折手术后伤口感染的风险 [7]。膝关节置换术后，吸烟似乎对早期恢复阶段影响最大 [16]。对于舟骨（腕部的一块小骨）骨折，吸烟和使用无烟烟草都被列为提示骨骼可能不愈合的征象 [17]。

并非所有风险都已得到证实。一项针对某种特定类型下腰椎手术的研究发现，在使用标准技术时，吸烟并没有减慢骨融合 [19]。在这种情况下，较新的技术和促进骨愈合的添加物可能会抵消吸烟的部分影响 [20]。因此，并非每种手术的情况都相同。

最明确的风险是您可以改变的那一个。在肩袖手术中，尼古丁是一个可改变的风险因素 [10]。在肩袖修复术前超过6个月戒烟，与从不吸烟的人相比，感染或翻修手术的发生率没有可检测到的升高 [11]。

这适合您吗？

这里没有简单的"是"或"否"。吸烟并不会让您失去手术的资格，但它会改变您和医生需要进行的讨论内容。证据表明，从腕部骨折到肩关节和膝关节置换，烟草和尼古丁会影响许多手术后的愈合。因此，问题不在于您能否接受手术，而更多在于如何让您的身体获得良好愈合的最佳机会。

这就是筛查很重要的原因。建议外科医生询问每一位舟骨骨折患者是否吸烟或使用无烟烟草 [17]，并在前交叉韧带重建术前询问所有形式的烟草使用情况 [4, 5]。来自烟草以外来源的尼古丁也属于这项检查的一部分 [21]。如果您使用其中任何一种，尽早告诉医生意味着您可以提前做好安排，包括在手术日期之前很早就戒烟。

有些情况需要格外注意。如果您目前吸烟或最近吸烟，并将接受肩关节置换，研究提示住院至少2晚可能对早期恢复阶段有帮助 [22]。而膝关节置换术后，吸烟似乎对早期恢复影响最大 [16]，因此在最初几周内进行更密切的随访可能会带来改变。

这是一个需要共同做出的决定。请如实告诉医生您吸烟或使用尼古丁的情况，询问这对您的具体手术意味着什么，并将上面风险部分所述的风险与您希望获得的益处进行权衡。医生可以帮助您决定手术时机，以及先戒烟是否适合您。

核心要点

如果您吸烟或使用任何形式的尼古丁，在手术前戒掉是值得的。戒烟是您唯一可以改变的风险因素，而且戒得越早越好。吸烟者的手术仍然可以取得效果，但没有尼古丁拖慢愈合，您的身体会获得更好的愈合机会。最需要注意的一点是：任何来源的尼古丁，包括尼古丁袋和口香糖，同样会影响愈合，因此仅仅停止使用烟草可能还不够。

参考文献

[1] 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

[2] 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

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

[4] 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

[5] 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

[6] 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

[7] Adverse effect of smoking on surgical site infection following ankle and calcaneal fracture fixation: a meta-analysis. EFORT Open Reviews. 2024. DOI: 10.1530/EOR-23-0139

[8] The impact of nicotine dependence on postoperative complications following humeral shaft fracture repair. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100732

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

[10] Editorial Commentary : Tobacco or Not—All Nicotine Products Negatively Impact Rotator Cuff Surgery. Arthroscopy. 2026. DOI: 10.1002/arj.70199

[11] 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

[12] 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

[13] Nontobacco Nicotine Dependence and Rates of Periprosthetic Joint Infection and Other Postoperative Complications in Shoulder Arthroplasty: A Retrospective Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00706

[14] Nontobacco Nicotine Dependence Is Associated With Perioperative Complications and Repeat Surgery After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2026. DOI: 10.1002/arj.70189

[15] 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

[16] 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

[17] 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

[18] 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

[19] 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

[20] 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

[21] 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

[22] Smoking is an independent risk factor for complications in 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].
Heated tobacco use has a similar deleterious effect on rotator cuff repair healing as cigarette smoking [2].
Pack-years and duration of cessation serve as independent predictors of tendon healing after arthroscopic rotator cuff repair [3].
Surgeons should consider asking all patients with scaphoid fractures if they use smokeless tobacco or smoke to identify patients at risk for nonunions [4].
Active smokers are at an increased risk of both medical and surgical complications following elective knee or hip arthroplasty [5].
Patient factors that influence lesser tuberosity osteotomy healing in stemmed and stemless anatomic shoulder arthroplasty include a greater BMI and tobacco use [6].
Heated tobacco users have worse clinical outcomes with respect to rotator cuff healing than nonsmokers, similar to conventional cigarette smokers [7].
Smoking is associated with a higher risk for complications than smokeless tobacco use following total knee arthroplasty [8].
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 between cohorts [9].
Smokeless tobacco use is associated with increased perioperative complications and revision surgery after anterior cruciate ligament reconstruction [10, 11].
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 [12].
Cessation of smoking is highly advised for medial meniscus allograft transplantation and meniscus repair performed in the presence of concurrent ligamentous injury [13].
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 [14].
Smokeless tobacco use is associated with higher rates of medical- and joint-related complications following primary total hip arthroplasty [15].
Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol for total knee arthroplasty [16].

How It Works

Tobacco use is a patient factor that influences lesser tuberosity osteotomy healing in stemmed and stemless anatomic shoulder arthroplasty [6].
Heated tobacco users have worse clinical outcomes with respect to rotator cuff healing than nonsmokers [7].
Current smokers may have poorer functional outcomes after reverse total shoulder arthroplasty compared to former smokers and nonsmokers [9].
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 [12].
Cessation of smoking is highly advised for meniscus repair performed in the presence of concurrent ligamentous injury [13].
Smoking is a modifiable risk factor that should be addressed to improve outcomes and reduce costs associated with complications in patients undergoing shoulder arthroplasty [14].
Cigarette smoking was not associated with impaired radiographic fusion after TLIF with adjunctive posterolateral arthrodesis performed using a standardized technique [17].
Former smokers who quit more than 6 months prior to rotator cuff repair are not at a detectably elevated risk of infection or revision surgery compared with those who have never smoked [18].
Smoking may primarily affect the early recovery trajectory rather than pain-related outcomes alone following primary total knee arthroplasty [19].
Nicotine has a dose-dependent effect on bone healing, bone growth, and implant integration [20].
Nicotine use is a modifiable risk factor in rotator cuff surgery [21].
Smoking has a negative effect on anatomical total shoulder arthroplasty functional outcomes that may persist even after quitting [22].
Nicotine dependence prior to surgical fixation of humeral shaft fractures is associated with a 60-110% increased risk for surgical complications including postoperative infection, wound disruption, nonunion and reoperation [23].
Nontobacco nicotine dependence is associated with higher 90-day rates of wound disruptions, infections, sepsis, as well as increased rates of mechanical loosening and prosthetic joint infection at 2 years postoperatively after shoulder arthroplasty [24].
Smoking is a significant risk factor for surgical site infection following ankle and calcaneal fracture fixation [26].

What the Evidence Shows

Spine and Arthrodesis

Shoulder and Rotator Cuff

Patient factors that influence lesser tuberosity osteotomy healing in anatomic shoulder arthroplasty include a greater BMI and tobacco use [6].
The incidence of complications and revision surgery after reverse total shoulder arthroplasty does not differ significantly between current smokers, former smokers, and nonsmokers [9].
At 2 and 5 years, nontobacco nicotine dependence showed increased odds of subsequent cuff repair and manipulation under anesthesia or debridement versus controls after arthroscopic rotator cuff repair [30].

Knee and Hip Arthroplasty

Smokeless tobacco use is associated with worse outcomes following total knee arthroplasty [8].
Differences in follow-up communication suggest that smoking may primarily affect the early recovery trajectory rather than pain-related outcomes alone following primary total knee arthroplasty [19].

Ligament Reconstruction

Smokeless tobacco use is associated with perioperative complications and revision surgery after anterior cruciate ligament reconstruction [11].
Non-smokers were significantly more likely to achieve superior functional outcomes following ACL reconstruction compared to smokers [28].
Anterior cruciate ligament graft failure rates are comparable between smokers and non-smokers [28].

Fractures and Bone Healing

Cannabis and nicotine use were independently associated with increased postoperative complications following fixation of upper extremity fractures compared with matched non-user controls [29].
Nicotine has a dose-dependent effect on bone healing, bone growth, and implant integration, as demonstrated in various animal and in vitro studies [20].

Cartilage and Meniscus

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 [12].

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 [4].
Specific forms of tobacco use should be considered in preoperative screening for patients undergoing anterior cruciate ligament reconstruction [10, 11].
Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol [16].
Smoking is a modifiable risk factor that should be addressed to improve outcomes and reduce costs associated with complications and joint replacement in patients undergoing shoulder arthroplasty [14].

Cessation Timing and Duration

Impact on Healing and Outcomes

Smoking is associated with higher risk for complications than smokeless tobacco use following total knee arthroplasty [8].
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 [9].
Patient factors that influence lesser tuberosity healing in stemmed and stemless anatomic shoulder arthroplasty include a greater body mass index and tobacco use [6].
Smoking is an independent risk factor for complications in outpatient total shoulder arthroplasty [27].

Mitigation and Management

Cessation of smoking is highly advised for meniscus repair performed in the presence of concurrent ligamentous injury to reduce factors that may contribute to failure [13].
Current or recent smokers undergoing total shoulder arthroplasty may benefit from an inpatient setting of minimum 2 nights [27].
Nicotine use is a modifiable risk factor, and using research to guide patients on the safest path to recovery is impactful for rotator cuff surgery [21].

Key Evidence

[L3] Contemporary techniques and biologic augmentation may mitigate the adverse effects of smoking in this setting. [1] (10.1097/corr.0000000000003999)
[L4] This novel study shows that heated tobacco use has a similar deleterious effect on rotator cuff repair healing as cigarette smoking. [2] (10.2106/jbjs.24.00192)
[L3] Pack-years and duration of cessation serve as independent predictors of tendon healing. [3] (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. [4] (10.5435/jaaos-d-23-00188)
[L1] The literature reveals that active smokers are at an increased risk of both medical and surgical complications. [5] (10.1016/j.arth.2024.10.035)
[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] Heated tobacco users, like conventional cigarette smokers, have worse clinical outcomes with respect to rotator cuff healing than nonsmokers. [7] (10.2106/jbjs.23.00804)
[L3] However, smoking is associated with higher risk for complications than smokeless tobacco use. [8] (10.1016/j.arth.2023.01.035)
[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. [9] (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. [10] (10.1177/2325967125s00229)
[L3] These findings highlight the importance of considering specific forms of tobacco use in preoperative screening for patients undergoing ACLR. [11] (10.1177/03635465241303487)
[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. [12] (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. [13] (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. [14] (10.1177/17585732251327368)
[L3] Smokeless tobacco use is associated with higher rates of medical- and joint-related complications following primary THA. [15] (10.1016/j.arth.2023.05.041)
[L3] Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol. [16] (10.5435/jaaos-d-23-01053)
[L2] Cigarette smoking was not associated with impaired radiographic fusion after TLIF with adjunctive posterolateral arthrodesis performed using a standardized technique. [17] (10.1097/corr.0000000000003844)
[L3] Former smokers who quit >6 months prior to rotator cuff repair are not at a detectably elevated risk of infection or revision surgery compared with those who have never smoked. [18] (10.1016/j.jse.2023.03.007)
[L3] Differences in follow-up communication suggest that smoking may primarily affect the early recovery trajectory rather than pain-related outcomes alone. [19] (10.1016/j.arth.2026.04.018)
[L2] Nicotine has a dose-dependent effect on bone healing, bone growth, and implant integration, as demonstrated in various animal and in vitro studies. [20] (10.1186/s13018-026-06733-3)
[L5] It highlights that nicotine use is a modifiable risk factor and that using research to guide patients on the safest path to recovery is impactful. [21] (10.1002/arj.70199)
[L3] Smoking has a negative effect on anatomical total shoulder arthroplasty functional outcomes that may persist even after quitting. [22] (10.1302/0301-620x.106b11.bjj-2024-0202.r1)
[L3] Nicotine dependence prior to surgical fixation of humeral shaft fractures is associated with a 60-110% increased risk for surgical complications including postoperative infection, wound disruption, nonunion and reoperation. [23] (10.1016/j.xrrt.2026.100732)
[L3] Nontobacco nicotine dependence is associated with higher 90-day rates of wound disruptions, infections, sepsis, as well as increased rates of mechanical loosening and prosthetic joint infection at 2 years postoperatively after shoulder arthroplasty. [24] (10.5435/jaaos-d-24-00706)
[L1] Smoking is a significant risk factor for surgical site infection following ankle and calcaneal fracture fixation. [26] (10.1530/EOR-23-0139)
[L3] Current or recent smokers may benefit from an inpatient setting of minimum 2 nights. [27] (10.1016/j.jseint.2023.07.009)
[L1] Nonetheless, non-smokers were significantly more likely to achieve superior functional outcomes following ACL reconstruction. [28] (10.1002/ksa.70146)
[L3] Cannabis and nicotine use were independently associated with increased postoperative complications following fixation of upper extremity fractures compared with matched non-user controls. [29] (10.1186/s13018-025-06635-w)
[L3] At 2 and 5 years, NTND showed increased odds of subsequent cuff repair and manipulation under anesthesia or debridement versus controls. [30] (10.1002/arj.70189)

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

[3] 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

[4] 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

[5] 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

[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] 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

[8] 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

[9] 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

[10] 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

[11] 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

[12] 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

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

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

[15] 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

[16] 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

[17] 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

[18] 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

[19] 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

[20] 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

[21] Editorial Commentary : Tobacco or Not—All Nicotine Products Negatively Impact Rotator Cuff Surgery. Arthroscopy. 2026. DOI: 10.1002/arj.70199

[22] The effect of smoking on functional outcomes and implant survival of anatomical total shoulder arthroplasty. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0202.r1

[23] The impact of nicotine dependence on postoperative complications following humeral shaft fracture repair. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100732

[24] Nontobacco Nicotine Dependence and Rates of Periprosthetic Joint Infection and Other Postoperative Complications in Shoulder Arthroplasty: A Retrospective Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00706

[26] Adverse effect of smoking on surgical site infection following ankle and calcaneal fracture fixation: a meta-analysis. EFORT Open Reviews. 2024. DOI: 10.1530/EOR-23-0139

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

[28] 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

[29] Cannabis and nicotine use are independently associated with adverse surgical, medical, and psychosocial outcomes following upper extremity fracture fixation. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-025-06635-w

[30] Nontobacco Nicotine Dependence Is Associated With Perioperative Complications and Repeat Surgery After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2026. DOI: 10.1002/arj.70189