The summary of this article says much of it:
* Cigarette smoking decreases bone mineral density and increases the risk of sustaining a fracture or tendon injury, with partial reversibility of these risks with long-term cessation of smoking.
* Cigarette smoking increases the risk for perioperative complications, nonunion and delayed union of fractures, infection, and soft-tissue and wound-healing complications.
* Brief preoperative cessation of smoking may mitigate these perioperative risks.
* Informed-consent discussions should include notification of the higher risk of perioperative complications with cigarette smoking and the benefits of temporary cessation of smoking
* Cigarette smoking increases the risk for perioperative complications, nonunion and delayed union of fractures, infection, and soft-tissue and wound-healing complications.
* Brief preoperative cessation of smoking may mitigate these perioperative risks.
* Informed-consent discussions should include notification of the higher risk of perioperative complications with cigarette smoking and the benefits of temporary cessation of smoking
The authors of this most informative review point to the specific effects of smoking: diminution of tissue perfusion and oxygenation, increase in platelet aggregation, vascular damage, increase in blood clotting, interference with oxidative metabolism, and decreased immunity to infection (affecting both the antibody response and the cellular response).
From an orthopaedic standpoint, smoking reduces bone blood flow and can lead to osteonecrosis (bone death) and can reduce osteoblast function and osteogenesis and can interfere with fracture healing. Interestingly, not all the effects of smoking are due to nicotine; other tobacco extracts can also impair bone healing and the strength of healing fractures.
Calcium absorption is decreased in smokers and increased rates of fracture of the hip, spine, and distal forearm. Smoking may increase the rate of bone loss related to menopause and aging. It was found to be an independent indicator of unintentional injuries.
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We take it further: we question the value of elective orthopaedic surgery in the presence of active use of nicotine - the evidence suggests that rotator cuff repairs, bone grafting, and the subscapularis repair after shoulder arthroplasty all have an increased risk of failure in addition to the overall perioperative risk to the patient's health (The most common perioperative complications associated with smoking are wound-healing, infection, and cardiopulmonary complications). When with thing of the four "P"s (the problem, the patient, the procedure and the performing surgeon) this is a great example of the importance of the 'second P'. Beyond the direct effects of smoking, we consider that active use of nicotine suggests a suboptimal patient dedication to optimizing health - this dedication is important to achieving the best result from elective surgery.
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Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
See from which cities our patients come.
See the countries from which our readers come on this post.