Shoulder surgery, like any surgery, doesn’t come without its risks. However, in certain patients these risks are elevated. And it seems that smokers are particularly vulnerable to complications after shoulder surgery.

The impact of tobacco use on complications after hip and knee surgery has been well documented, but a recent study in The Bone and Joint Journal has looked at whether smokers are at increased risk of poor medical and surgical outcomes after shoulder arthroplasty.

Here, we’ll look at how smoking increases risks after shoulder surgery and why now is a great time to quit.

What risks do smokers face after surgery?

According to studies, the main risks smokers face after surgery include poor wound healing, infection and less than optimal final outcomes.

The study in The Bone and Joint Journal analysed a total of 196,325 non-smokers (93.1%) and 14,461 smokers (6.9%) that underwent TSA during a five-year study period. Smokers had increased rates of 30- and 90-day readmission, revision within 90 days, infection, wound complications, and instability of the prosthetic joint.

In another study, featuring 235 patients, it was discovered that good results were seen in 84% of non-smokers, yet just 35% in smokers. This shows just how significant the effects of smoking can be. With less than half of smokers experiencing good results, it shows just how significant the risks are.

Smokers have also been found to suffer more pain before and after shoulder surgery. This is because cigarettes have a detrimental impact on the healing of the bone and soft tissue. Infection rates are also higher and there is also an increased risk of surgical revision.

Why does smoking increase shoulder surgery risks?

The reason smoking increases the risks of surgery is because it causes the heart and lungs to not function as well as they should. This can lead to breathing difficulties during and after the procedure.

Smoking is also known to reduce blood flow. This is what slows down the healing process, increasing the risk of infection. It is also known to contribute towards heart disease. This in turn will increase the risk of a heart attack during and after surgery.

Will quitting before the surgery make a difference?

Smokers are always recommended to quit prior to undergoing surgery. Did you know that even if you just quit the day before the surgery, it can still greatly reduce the risks? This is down to the fact that the minute you stop smoking, the body automatically starts to heal itself. All of the harmful chemicals and toxins start to decrease immediately. This improves blood flow, reducing the risk of poor healing.

However, while you can benefit from stopping the day before, the sooner you quit the better the outcome will be. Ideally, you should quit at least a week before the surgery. You’ll also want to avoid smoking during recovery. For this reason, it is the perfect time for smokers to quit for good.

All of the evidence collected through numerous studies, points to smokers having increased risks during and after shoulder surgery. While patients obviously know smoking isn’t good for their health, few realise just how much it increases their risk of recovery. If you need shoulder surgery and you’re a smoker, now is the time to think of quitting for good. If you don’t, you may not receive the best results and you could end up needing a revision surgery.

For more advice on how best to prepare for shoulder surgery, call us on 0203 195 2442.

A new study, published within the Journal of Shoulder and Elbow Surgery, has discovered a link between frozen shoulder and fasting glucose levels. The association between frozen shoulder and diabetes is nothing new, but very little is currently known about the link regarding fasting glucose levels.

Interestingly, a link was discovered in fasting glucose levels of 90-99 mg/dL which are considered to be normoglycemic. Levels below this range haven’t shown any corresponding connection. In fact, fasting glucose levels under 85 mg/dL showed a negative association.

So, there is certainly a link between the shoulder and blood sugar levels. The question is, what is the relationship between frozen shoulder and diabetes?

Frozen shoulder and diabetes

The American Diabetes Association states that around 10% to 20% of those with diabetes, go on to suffer from frozen shoulder at some point in their lives. When you consider the rate is just 2% to 5% in the general population, you can see the increased risk diabetes poses.

Frozen shoulder is otherwise known as adhesive capsulitis and it progresses slowly over time. It occurs as the ball and socket joint of the shoulder starts to lose its mobility.

Eventually, it becomes frozen or immobilised. This means the arm cannot be moved over the head and daily tasks become extremely difficult.

It is thought that the condition can be triggered by high blood sugar levels. These attach to the ligaments and tendons, causing them to become weaker and stiffer. In turn, this causes inflammation. When you combine this with the circulation issues caused by high blood sugar levels, it can worsen the stiffness in the socket.

Generally speaking, the longer a patient lives with diabetes, the bigger the risk there is it will lead to frozen shoulder.

The importance of early treatment

Although it can be challenging to identify the symptoms of frozen shoulder early on, the sooner you can seek treatment, the better. Patients who do have diabetes should take care to control their blood sugar levels. This is the only way to reduce the risk of developing diabetes-related frozen shoulder.

For patients who are experiencing frozen shoulder, treatment includes physiotherapy and anti-inflammatory medications. Steroid injections can also prove useful. However, for those with diabetes these aren’t always suitable as they can lead to high blood sugar levels. In severe cases, surgery may be required to correct the issue.

If you are worried you might be experiencing frozen shoulder, book a consultation with a specialist today. They will be able to diagnose the cause of the condition and recommend the best course of treatment moving forward.

Rotator cuff disease, or trauma to the rotator cuff, is a common complaint and can be caused by an injury, overuse whether due to sporting endeavour or employment, or can occur without any obvious cause.

A new study has helped to identify risk factors that increase the need for shoulder surgery as a result of rotator cuff disease. The population-based cohort study is one of the largest of its kind. Here, we’ll look at what it revealed, and you’ll discover more about rotator cuff injuries.

Understanding the new study

The recent large-scale study included data from 421,894 patients, with 47% being male. Participants were aged between 40-69 and the UK’s Biobank was used for the research. NHS inpatient records were used to identify patients who had undergone surgery for rotator cuff disease.

Hazard ratios were calculated using Multivariate Cox proportional hazards regression. The main risk factors discovered were sex, age, race, BMI, smoking, occupational demands and the Townsend deprivation index.

Interestingly, the study found that every additional 10 years of age contributed to a 55% increase in surgery rates for rotator cuff disease. A high BMI, non-white races and a lower deprivation score also contributed to an increased risk of surgery.

The majority of the risks identified are known to be modifiable. This means the risks can be reduced through healthier lifestyle choices.

The link between depression and rotator cuff tears

Although this new study is one of the largest of its kind, there have been previous smaller studies carried out that are worth referencing. In 2019, a study looked into the link between depression and rotator cuff tears and it produced some surprising results.

Depressive disorders are known to be associated with chronic systemic inflammation. Depression, for example, is associated with chronic diseases such as coronary artery disease and chronic obstructive pulmonary disease. So, how does this link to rotator cuff tears?

Although the underlying mechanism of how depression is associated with rotator cuff tears remains uncertain, it’s thought that inflammation not only plays a role in the onset of tendon injury but also then negatively impacts repair of injured tendons. Furthermore, depression could heighten the sensation of pain associated with rotator cuff disease in those patients suffering from depression.

Further research is needed to determine exactly how the two conditions are associated. However, the evidence so far does support they are connected. Patients with depression are more likely to require surgery for a rotator cuff tear than those without the mental health condition.

What is a rotator cuff tear?

The rotator cuff of the shoulder consists of numerous muscles and tendons which cushion the shoulder joint. It is responsible for keeping the upper arm bone within the shoulder socket. A tear can occur in any of the muscles or tendons surrounding the joint.

Usually, rotator cuff tears are caused by overuse or repetitive motions. However, they can occur as a single injury. They vary in severity and in some cases, surgery may be the only way to repair the injury.

While surgery can be an effective solution to the pain and lack of mobility associated with a rotator cuff tear, there are always risks associated with surgery that need to be considered. The new study suggests that healthier lifestyle choices may reduce the need for surgery. If you suspect you have rotator cuff disease, call 0203 195 2442 to arrange a consultation with the London Shoulder Specialists.

Published last year in the Annals of the Royal College of Surgeons and now available to the public, is an in-depth analysis of research conducted in the field of rotator cuff repair titled. ‘Degenerative rotator cuff tear, repair or not repair? A review of current evidence’. The goal was to address whether a surgical or non-surgical approach would be better for patients. Among the study’s authors were three members of the London Shoulder Specialists; Mr Ali Narvani, Mr Steven Corbett and Mr Andrew Wallace.

Here, we’ll review the evidence that was revealed and what it means for those suffering from a rotator cuff tear.

Clinical outcomes for non-surgical repairs

In our analysis of research relating to clinical outcomes for non-surgical repairs, we found results were dependent upon the severity of the tear. The review focused on a multicentre study which included 452 patients who had atraumatic rotator cuff tears. They were treated with physiotherapy and reviewed at 6 and 12 weeks. Significant improvements were identified at both the 6- and 12-week review, although after two years, 26% of patients chose to undergo surgery.

It appears non-surgical treatment provides great early results, but patients still often go on to need surgery. Those with large and severe rotator cuff tears experienced the fewest benefits of non-operative treatment. In fact, for older patients with massive tears, the problem simply became worse over time. This is particularly true for patients with tears that affected three or more tendons.

Clinical outcomes for surgical repairs

A lot of studies have been carried out to determine the effectiveness of surgical rotator cuff repair. In one study which involved data from 1600 patients, it showed after six months there was a significant improvement in most patients in overhead motion and pain.

Another looked at surgical repair of full thickness tears. A total of 263 shoulders were included in the study. After five years, 94% of patients didn’t require any further surgery. Most impressively, after 10 years 83% of patients still didn’t require additional surgery.

So, surgical repair does appear to be more effective in the long term. However, it did take six months for patients to experience full improvements. This is slightly longer than the initial outcome for non-surgical treatment.

The role of age in rotator cuff repair results

There were conflicting results in the studies regarding whether age played a role in results. It is widely believed that age does impact the outcome of rotator cuff repair. However, some studies showed that there were no differences between the results experienced in younger age groups and those in older groups.

The only exception here is tendon healing. Evidence suggests that older patients do appear to take longer to heal when tendons are damaged. However, for most rotator cuff repairs, surgery had the same success rate in older patients as it did in younger ones.

The findings of the review confirm that rotator cuff repair surgery does tend to be the best option for patients. However, it does depend upon the size and severity of the tear. For patients experiencing a mild tear, physiotherapy and a non-surgical approach can be effective. However, for more severe and larger tears, surgery is the most effective option.

During the current COVID-19 crisis, all non-urgent / elective surgery bookings and appointments are postponed. These are now restarting though there are some restrictions in a quickly-changing landscape, but the London Shoulder Specialists are still available for consultation if you require more advice on rotator cuff repair. Consultations can be carried out either by telephone or video link and can be arranged by emailing appointments@fortiusclinic.com or by calling 020 3195 2442.