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El tabaquismo y la cicatrización musculoesquelética
How smoking and nicotine affect bone healing, fracture union, spinal fusion, tendon and wound healing, and surgical complications — and the benefits of stopping before surgery.
Qué es¶
Fumar afecta a algo más que a los pulmones y al corazón. También frena la capacidad de su cuerpo para curarse después de una cirugía de huesos, articulaciones, tendones y ligamentos. Esta página explica por qué y qué significa para su operación.
La nicotina, la sustancia química adictiva del tabaco, estrecha los pequeños vasos sanguíneos que llevan oxígeno y nutrientes al tejido en cicatrización. Tiene un efecto dependiente de la dosis sobre la consolidación ósea, el crecimiento del hueso y la integración de los implantes [1]. Eso significa que cuanta más nicotina recibe su cuerpo, más puede interferir con la cicatrización. El hueso necesita un aporte de sangre constante para soldarse, y los implantes necesitan un hueso sano en el que asentarse.
Los efectos se observan en muchos tipos de cirugía. Los fumadores tienen un mayor riesgo de complicaciones médicas y quirúrgicas después de una prótesis programada de cadera o de rodilla [2]. Después de la reparación del manguito rotador, los productos de tabaco calentado tienen un efecto perjudicial sobre la cicatrización del tendón similar al de los cigarrillos [3]. El tabaco sin humo se asocia a más complicaciones después de la reconstrucción del LCA [4, 5] y después de una prótesis de cadera [6]. En la cirugía de fracturas de tobillo y de talón, fumar aumenta el riesgo de infección de la herida [7]. La dependencia de la nicotina antes de una cirugía de fractura de la parte superior del brazo conlleva un aumento del 60-110% del riesgo de complicaciones como infección, dehiscencia de la herida, seudoartrosis (una fractura que no llega a consolidar) y reintervención [8].
La buena noticia es que fumar es un factor de riesgo modificable [9, 10]. Eso significa que es algo que usted puede cambiar. Dejarlo importa. Los exfumadores que lo dejaron más de 6 meses antes de la reparación del manguito rotador no muestran un aumento detectable de infecciones ni de cirugías de revisión en comparación con las personas que nunca han fumado [11]. Su médico puede hablar con usted sobre cómo dejar de fumar y sobre las opciones de sustitución de la nicotina, con bastante antelación a la fecha de su operación.
¿Funciona?¶
La respuesta sincera es que la cirugía puede seguir funcionando en los fumadores, pero las pruebas muestran que a menudo funciona peor. Los estudios sobre la prótesis de hombro encontraron que los fumadores actuales pueden tener peor función después que las personas que nunca han fumado o que lo han dejado [12]. La tasa de complicaciones y de cirugías de revisión fue similar entre los grupos [12]. Así que el implante en sí puede aguantar, pero la sensación y el movimiento de su hombro pueden no alcanzar el mismo nivel.
La nicotina por sí sola, sin tabaco, también importa. La investigación sobre la prótesis de hombro encontró que la dependencia de la nicotina procedente de fuentes distintas del tabaco se asociaba a más dehiscencias de la herida e infecciones en los primeros 90 días, y a más aflojamientos e infecciones articulares a los 2 años [13]. Después de una reparación artroscópica del manguito rotador, las personas con dependencia de la nicotina necesitaron más reparaciones posteriores del manguito y más procedimientos para liberar un hombro rígido o limpiar la articulación, tanto a los 2 como a los 5 años [14].
El mismo patrón aparece en otros ámbitos. Después de la reconstrucción del LCA, las personas que nunca habían fumado tenían más probabilidades de recuperar una buena función de la rodilla que los fumadores [15]. En la prótesis de rodilla, fumar parece afectar al periodo inicial de recuperación más que solo a los niveles de dolor [16]. En la cirugía de fracturas, el efecto de la nicotina sobre la consolidación ósea depende de la dosis, y así se ha demostrado en estudios con animales y de laboratorio [1]. Se aconseja a los cirujanos que pregunten a todo paciente con una fractura de escafoides, un pequeño hueso de la muñeca, si fuma o consume tabaco sin humo, porque ambos aumentan la probabilidad de que la fractura no consolide [17].
Parte de estas pruebas son más sólidas que otras. Gran parte procede de grandes registros de pacientes, no de ensayos en los que las personas se reparten al azar en grupos. Algunos hallazgos son dispares. Un estudio encontró que fumar conllevaba un mayor riesgo de complicaciones que el tabaco sin humo después de una prótesis de rodilla [18], lo que sugiere que ningún producto de tabaco es claramente seguro en torno a la cirugía.
Lo que esto significa para usted es sencillo. Dejar de fumar antes de su operación da a su cuerpo la mejor oportunidad de curarse bien, y cuanto antes lo deje, mejor.
¿Cuáles son los riesgos?¶
Los riesgos principales son los ya descritos: cicatrización más lenta, problemas de la herida e infección. Pero hay algunos detalles que conviene conocer.
La nicotina de cualquier fuente, no solo de los cigarrillos, aumenta la probabilidad de dehiscencia de la herida, de infección y de propagación grave de la infección en los primeros 90 días después de una prótesis de hombro [13]. También aumenta la probabilidad de que el implante se afloje o se infecte a los 2 años [13]. Esto incluye la nicotina de las bolsitas, los chicles u otros productos que no contienen nada de tabaco.
Algunos riesgos dependen de dónde se opere. Fumar aumenta el riesgo de infección de la herida después de la cirugía de fracturas de los huesos del tobillo y del talón [7]. Después de una prótesis de rodilla, fumar parece afectar sobre todo al periodo inicial de recuperación [16]. En las fracturas de escafoides, un pequeño hueso de la muñeca, tanto fumar como el consumo de tabaco sin humo se señalan como indicios de que el hueso puede no consolidar [17].
No todos los riesgos están confirmados. Un estudio de un tipo concreto de operación de la parte baja de la columna encontró que fumar no retrasaba la fusión ósea cuando se utilizaba una técnica estándar [19]. Las técnicas más nuevas y los aditivos que favorecen la consolidación ósea pueden compensar algunos de los efectos del tabaco en ese contexto [20]. Así que el panorama no es el mismo en todas las operaciones.
El riesgo más claro es el que usted puede cambiar. La nicotina es un factor de riesgo modificable en la cirugía del manguito rotador [10]. Dejarlo más de 6 meses antes de la reparación del manguito rotador no muestra un aumento detectable de infecciones ni de cirugías de revisión en comparación con las personas que nunca han fumado [11].
¿Es adecuado para usted?¶
Aquí no hay un sí o un no sencillo. Fumar no le excluye de la cirugía, pero cambia la conversación que usted y su médico necesitan tener. Las pruebas muestran que el tabaco y la nicotina afectan a la cicatrización en muchas operaciones, desde las fracturas de muñeca hasta las prótesis de hombro y de rodilla. Así que la cuestión no es tanto si puede operarse, sino cómo dar a su cuerpo la mejor oportunidad de curarse bien.
Por eso es importante el cribado. Se aconseja a los cirujanos que pregunten a todo paciente con una fractura de escafoides si fuma o consume tabaco sin humo [17], y que pregunten por todas las formas de consumo de tabaco antes de una reconstrucción del LCA [4, 5]. La nicotina procedente de fuentes distintas del tabaco también forma parte de esa comprobación [21]. Si consume alguno de estos productos, decírselo pronto a su médico permite planificarlo, incluido dejarlo con bastante antelación a la fecha de su operación.
Algunas situaciones requieren un cuidado adicional. Si es fumador actual o reciente y se va a someter a una prótesis de hombro, la investigación sugiere que una estancia hospitalaria de al menos 2 noches puede ayudar en el periodo inicial de recuperación [22]. Y después de una prótesis de rodilla, fumar parece afectar sobre todo a la recuperación inicial [16], así que un seguimiento más estrecho en esas primeras semanas puede marcar la diferencia.
Se trata de una decisión compartida. Hable con sinceridad de su consumo de tabaco o nicotina, pregunte qué significa para su operación concreta y sopese los riesgos descritos en la sección anterior frente al beneficio que espera obtener. Su médico puede ayudarle a decidir el momento adecuado y si le conviene dejarlo primero.
Conclusión¶
Si fuma o consume nicotina en cualquier forma, merece la pena dejarlo antes de su operación. Es el único factor de riesgo que usted puede cambiar, y cuanto antes lo deje, mejor. La cirugía puede seguir funcionando en los fumadores, pero su cuerpo tiene más posibilidades de curarse bien sin que la nicotina lo frene. La advertencia principal: la nicotina de cualquier fuente, incluidas las bolsitas y los chicles, también afecta a la cicatrización, así que dejar solo el tabaco puede no ser suficiente.
Referencias¶
[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
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[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
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