Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-07-2019 | Orthopaedic Surgery

Tobacco use predicts poorer clinical outcomes and higher post-operative complication rates after open elbow arthrolysis

Authors: Ziyang Sun, Wei Wang, Cunyi Fan

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2019

Abstract

Introduction

Tobacco use is a worldwide public health problem, and has been found to be a predisposing factor for adverse functional outcomes and increased postoperative complication rates after various orthopedic operations. The purpose of this study was to determine the potential impact of tobacco use on open arthrolysis for post-traumatic elbow stiffness.

Materials and methods

A database search identified 145 patients with open arthrolysis performed for post-traumatic elbow stiffness; these were divided into three groups: current tobacco users (37), former users (28), and nonusers (80). All surgeries were performed using the same technique by the same doctor. General patient data, functional performance, and complications were documented and analyzed.

Results

Demographic data and disease characteristics were comparable at baseline. Postoperatively, significant differences were found among the three groups in terms of range of motion (P < 0.001), Mayo Elbow Performance Score (P = 0.006), visual analog scale score for pain (P = 0.015), Dellon classification for ulnar nerve symptoms (P = 0.013), and total complication rates (P < 0.001). The current tobacco users group had the poorest clinical outcomes and highest complication rates, while no significant differences were found between former users and nonusers.

Conclusions

Current tobacco users reported increased risk of poorer clinical outcomes and higher postoperative complication rates after open arthrolysis. Former users were found to have outcomes similar to those of nonusers. This study underlines the importance of discontinuing tobacco use for patients with post-traumatic elbow stiffness who are considering open arthrolysis.

Level of evidence

Level III; Retrospective Cohort Design; Therapeutic Study.

Bierut LJ (2009) Nicotine dependence and genetic variation in the nicotinic receptors. Drug Alcohol Depend 104(Suppl 1):S64–S69CrossRefPubMedPubMedCentral

Blonna D, Wolf JM, Fitzsimmons JS, O’Driscoll SW (2013) Prevention of nerve injury during arthroscopic capsulectomy of the elbow utilizing a safety-driven strategy. J Bone Jt Surg Am Vol 95(15):1373–1381CrossRef

Cai J, Liu J, Fan C (2015) Open arthrolysis combined with internal fixator removal for post-traumatic elbow stiffness. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chin J Reparative Reconstr Surg 29(7):826–830

Cai J, Wang W, Yan H et al (2015) Complications of open elbow arthrolysis in post-traumatic elbow stiffness: a systematic review. PLoS One 10(9):e0138547CrossRefPubMedPubMedCentral

Dahlin E, Dahlin E, Andersson GS, Thomsen NO, Bjorkman A, Dahlin LB (2017) Outcome of simple decompression of the compressed ulnar nerve at the elbow—influence of smoking, gender, and electrophysiological findings. J Plast Surg Hand Surg 51(2):149–155CrossRefPubMed

Dellon AL (1989) Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg 14(4):688–700CrossRef

Duchman KR, Gao Y, Pugely AJ, Martin CT, Noiseux NO, Callaghan JJ (2015) The effect of smoking on short-term complications following total hip and knee arthroplasty. J Bone Jt Surg Am Vol 97(13):1049–1058CrossRef

Cederbye F, Norberg R (2008) WHO report on the global tobacco epidemic 2011: warning about the dangers of tobacco. Geneva Switzerland WHO 34(3):581–581

Green BN, Johnson CD, Snodgrass J, Smith M, Dunn AS (2016) Association between smoking and back pain in a cross-section of adult Americans. Cureus 8(9):e806PubMedPubMedCentral

10.

Guitton TG, Zurakowski D, van Dijk NC, Ring D (2010) Incidence and risk factors for the development of radiographic arthrosis after traumatic elbow injuries. J Hand Surg 35(12):1976–1980CrossRef

11.

Hastings H 2nd, Graham TJ (1994) The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clin 10(3):417–437PubMed

12.

Hildebrand KA, Zhang M, Befus AD, Salo PT, Hart DA (2014) A myofibroblast-mast cell-neuropeptide axis of fibrosis in post-traumatic joint contractures: an in vitro analysis of mechanistic components. J Orthop Res 32(10):1290–1296CrossRefPubMed

13.

Kodde IF, van Rijn J, van den Bekerom MP, Eygendaal D (2013) Surgical treatment of post-traumatic elbow stiffness: a systematic review. J Shoulder Elb Surg 22(4):574–580CrossRef

14.

Kong L, Liu Z, Meng F, Shen Y (2017) Smoking and risk of surgical site infection after spinal surgery: a systematic review and meta-analysis. Surg Infect 18(2):206–214CrossRef

15.

Li D, Hu J, Wang T et al (2016) Silymarin attenuates cigarette smoke extract-induced inflammation via simultaneous inhibition of autophagy and ERK/p38 MAPK pathway in human bronchial epithelial cells. Sci Rep 6:37751CrossRefPubMedPubMedCentral

16.

Li F, Liu S, Fan C (2013) Lentivirus-mediated ERK2 siRNA reduces joint capsule fibrosis in a rat model of post-traumatic joint contracture. Int J Mol Sci 14(10):20833–20844CrossRefPubMedPubMedCentral

17.

Liu J, Chen S, Fan C (2018) Treatment of elbow joint stiffness by open release combined with distal radius fixation hinged external fixation. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chin J Reparative Reconstr Surg 32(2):134–138

18.

Mayne SL, Widome R, Carroll AJ et al (2018) Longitudinal associations of smoke-free policies and incident cardiovascular disease: CARDIA study. Circulation 138(6):557–566CrossRefPubMedPubMedCentral

19.

Moller AM, Villebro N, Pedersen T, Tonnesen H (2002) Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 359(9301):114–117CrossRefPubMed

20.

Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone J Surg Am Vol 63(6):872–877CrossRef

21.

Prasarn ML, Horodyski MB, Behrend C, Wright J, Rechtine GR (2012) Negative effects of smoking, workers’ compensation, and litigation on pain/disability scores for spine patients. Surg Neurol Int 3(Suppl 5):S366–S369CrossRefPubMedPubMedCentral

22.

Ranganathan K, Loder S, Agarwal S et al (2015) Heterotopic ossification: basic-science principles and clinical correlates. J Bone Jt Surg Am Vol 97(13):1101–1111CrossRef

23.

Richardson JK, Ho S, Wolf J, Spiegelberg T (2009) The nature of the relationship between smoking and ulnar neuropathy at the elbow. Am J Phys Med Rehabil 88(9):711–718CrossRefPubMed

24.

Rinker B, Fink BF, Barry NG et al (2011) The effect of cigarette smoking on functional recovery following peripheral nerve ischemia/reperfusion injury. Microsurgery 31(1):59–65CrossRefPubMed

25.

Sadr Azodi O, Bellocco R, Eriksson K, Adami J (2006) The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement. J Bone J Surg Br Vol 88(10):1316–1320CrossRef

26.

Shin NR, Park JW, Lee IC et al (2017) Melatonin suppresses fibrotic responses induced by cigarette smoke via downregulation of TGF-beta1. Oncotarget 8(56):95692–95703PubMedPubMedCentral

27.

Singh JA (2011) Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol 38(9):1824–1834CrossRefPubMedPubMedCentral

28.

Singh JA, Schleck C, Harmsen WS, Jacob AK, Warner DO, Lewallen DG (2015) Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study. BMC Med 13:283CrossRefPubMedPubMedCentral

29.

Sorensen LT, Jorgensen S, Petersen LJ et al (2009) Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res 152(2):224–230CrossRefPubMed

30.

Stienen MN, Smoll NR, Hildebrandt G, Schaller K, Gautschi OP (2014) Influence of smoking status at time of surgery for herniated lumbar disk on postoperative pain and health-related quality of life. Clin Neurol Neurosurg 122:12–19CrossRefPubMed

31.

Wang W, Zhan YL, Yu SY, Zheng XY, Liu S, Fan CY (2016) Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow. J Shoulder Elb Surg 25(5):816–822CrossRef

32.

Wells DB, Holt AM, Smith RA, Brolin TJ, Azar FM, Throckmorton TW (2018) Tobacco use predicts a more difficult episode of care after anatomic total shoulder arthroplasty. J Shoulder Elb Surg 27(1):23–28CrossRef

33.

Zhou Y, Cai JY, Chen S, Liu S, Wang W, Fan CY (2017) Application of distal radius-positioned hinged external fixator in complete open release for severe elbow stiffness. J Shoulder Elb Surg 26(2):e44–e51CrossRef

Title: Tobacco use predicts poorer clinical outcomes and higher post-operative complication rates after open elbow arthrolysis
Authors: Ziyang Sun
Wei Wang
Cunyi Fan
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-03109-z

At a glance: The STEP trials

Springer Medicine

Tobacco use predicts poorer clinical outcomes and higher post-operative complication rates after open elbow arthrolysis

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 7/2019

MRI in patients with Haglund’s deformity and its influence on therapy

Pain relieve without impairing muscle function after local infiltration anaesthesia in primary knee arthroplasty: a prospective randomized study

High complication and revision rates after total femoral replacement: a retrospective single center analysis of indication, function, and complication

Cement augmentation of the proximal humerus internal locking system in elderly patients: a multicenter randomized controlled trial

Contamination rate of the surgical gowns during total hip arthroplasty

Staged arthrodesis using the Masquelet technique for osteomyelitis of the finger with articular destruction: a report of two cases