Abstract:
BACKGROUND:Surgeons perform THA to address a variety of conditions in younger patients, including osteoarthritis (OA), osteonecrosis, inflammatory arthritis, and congenital deformities. Younger patients aged 50 years or younger have been characterized as active in the literature, but a direct relationship between age and activity level has not been well substantiated. Younger patients with OA may engage in higher activity levels; however, associated medical conditions in patients with other surgical indications may not support a generalization that age is a surrogate for activity level. We recently evaluated these issues in younger patients undergoing total knee arthroplasty (TKA) and noted that the majority would not be considered active. Given this observation, we considered whether younger patients undergoing THA are characterized by high activity levels, which is relevant to understanding the long-term risk of wear-related failures. QUESTIONS/PURPOSES:(1) Do demographic features of younger patients undergoing THA support high activity expectations? (2) Do preoperative or postoperative functional activity measures support projections that younger patients are active after THA? METHODS:We retrospectively compared demographic characteristics and functional activity profiles (as determined by preoperative and postoperative UCLA activity scores, Harris hip scores [HHS], and SF-12 and WOMAC physical function subscores) of 704 patients who had undergone THA and were aged younger than 50 years (822 hips) with those of 484 patients (516 hips) aged between 65 and 75 years, who had undergone THA, with a minimum followup at 1 year after surgery (range, 12-160 months). RESULTS:Compared with patients aged 65 to 75 years, younger patients undergoing THA were more often men (51%, 95% confidence interval [CI], 48.8%-53.2% versus 40%, 95% CI, 37.1%-42.9% women; p < 0.01) or had undergone surgery for osteonecrosis (29% versus 4%; 95% CI, 2.8%-5.2%; p < 0.001). Postoperative HHS, SF-12, and WOMAC scores were not appreciably different between the two patient groups. Compared with older patients, younger patients with OA had higher preoperative (5.0 ± 2.5 versus 3.9 ± 2.0, p < 0.001) and postoperative UCLA activity scores (6.8 ± 2.1 versus 5.3 ± 1.9, p < 0.001). Younger patients with diagnoses other than OA had slightly higher mean postoperative UCLA activity scores than older patients (6.0 ± 2.3 versus 5.3 ± 1.9; p < 0.001). Two hundred fifty-nine of 704 younger patients undergoing THA (37%; 95% CI, 34.9%-39.1%) returned to impact activity compared with 75 of 484 older patients undergoing THA (15.5%; 95% CI, 13.3%-17.7%) (p < 0.001). CONCLUSIONS:Younger patients with OA are likely to return to high levels of activity after surgery, which may impact long-term wear-related implant survivorship. High activity levels are less common among younger patients with diagnoses other than OA. Age is not the ideal surrogate for activity level in patients considering THA; instead, specific activity-level measures should be used when discussing patient expectations pertaining to postoperative activity levels after arthroplasty. LEVEL OF EVIDENCE:Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Keeney JA,Nunley RM,Baca GR,Clohisy JCdoi
10.1007/s11999-014-3952-8subject
Has Abstractpub_date
2015-03-01 00:00:00pages
1083-92issue
3eissn
0009-921Xissn
1528-1132journal_volume
473pub_type
杂志文章abstract::Development leading to local bone differentiation in response to intramuscular and subcutaneous implantation of demineralized bone matrix has been predominantly investigated in rodents. To investigate bone differentiation by induction in primates, diaphyseal bone was harvested from ten male baboons and chemosterilized...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-08-01 00:00:00
abstract::Increasing knowledge of instability in the shoulder has created a more complex evaluation sequence. The history continues to be important. Many physical examination maneuvers are available to further define the problem. Routine roentgenographic examination has been extended to include views specifically designed to de...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1987-10-01 00:00:00
abstract::Previously, a major limitation to percutaneous disc decompression to relieve symptoms of sciatica was the inability to approach the L5-S1 level. Obstruction by the iliac crest prevented the instrumentation from entering the L5-S1 disc space. In this paper, the authors describe a curved cannula which can be placed down...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract::The treatment of nonunion of the tibia in 40 patients by constant direct current was evaluated in a prospective survey. The method was simple to apply and the complication rate was low, but considerable cooperation is required on the part of patients. The success rate was 85%. When two patients who had significant fra...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-09-01 00:00:00
abstract::Temperature sensors were placed in 50 knees in 25 patients who had one or both joints replaced. Temperature recordings were made before walking, after walking, and after cycling. The heat generated in healthy, arthritic, and replaced knees was measured. The knee replacements were done using eight different prostheses....
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000183739.50869.bb
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Childhood obesity is a growing problem in America. Orthopaedic surgeons have an opportunity to interact with communities to educate children about healthy eating and physical activity. The American Academy of Orthopedic Surgeons (AAOS) Leadership Fellows Program [1] Class of 2012 created a presentation for A...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-012-2647-2
更新日期:2013-04-01 00:00:00
abstract::Considering the often poor results obtained with conventional methods of bone grafting in the treatment of congenital pseudarthrosis of the tibia, the free vascularized bone graft may offer the best chance of cure to these unfortunate patients. A segment of rib or fibula may be harvested with its vascular supply and u...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-06-01 00:00:00
abstract:UNLABELLED:Osteoporotic spinal deformities with global sagittal imbalance have devastating effects on patients. However, treatment is difficult and there is a high risk of perioperative medical and mechanical complications. Patients with osteoporotic spinal deformities are not ideal candidates for posterior pedicle sub...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000200237.22308.93
更新日期:2006-02-01 00:00:00
abstract:UNLABELLED:Structural deformities of the femoral head occurring during skeletal development (eg, Legg-Calvé-Perthes disease) are associated with individual shapes of the acetabulum but it is unclear whether differences in acetabular shape are associated with differences in proximal femoral shape. We questioned whether ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-008-0141-7
更新日期:2008-04-01 00:00:00
abstract::Aneurysmal bone cyst is a rare nonneoplastic expansile osteolytic bone lesion of unknown etiology. To the best of the authors' knowledge, no epidemiologic study concerning its incidence has been reported. The authors performed a retrospective, population based analysis of 94 patients with primary aneurysmal bone cyst ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1999-06-01 00:00:00
abstract:BACKGROUND:Above-knee amputation (AKA) is a rare but devastating complication of TKA. Although racial disparities have been previously reported in the utilization of TKA, it is unclear whether disparities exist in the rates of AKA after TKA. QUESTIONS/PURPOSES:(1) Which gender-racial group has the highest rate of AKA ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-016-5195-3
更新日期:2017-07-01 00:00:00
abstract::One hundred twenty-six primary total hip arthroplasties composed of a hybrid cemented femoral component and a cementless acetabular component were followed for a minimum of two years (mean, 42 months). The average patient age was 63 years. The most common diagnosis was osteoarthritis (85 hips), although 13 of the case...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1989-12-01 00:00:00
abstract::Symptomatic (Stage II) impingement of the rotator cuff against the coracoacromial arch has been treated with anterior acromioplasty in 60 shoulders in 56 patients. Patient selection is crucial. Arthrography of the shoulder was routinely included in the preoperative diagnostic tools to rule out a tear of the rotator cu...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:Anecdotal evidence from second-look hip arthroscopies and animal studies has suggested spontaneous labral regrowth may occur after débridement. However, these observations have not been systematically confirmed. QUESTIONS/PURPOSES:We (1) determined whether labral regrowth occurs after débridement in human h...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-2914-x
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Metal-on-metal articulations can release substantial amounts of particles containing cobalt and chromium into the surrounding milieu, causing concern for cellular toxicity and adverse local soft tissue reactions. The diameter of the femoral head has been one of the variables that inversely affects wear of me...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1630-z
更新日期:2011-06-01 00:00:00
abstract::The right hips of 69 five-day-old rabbits were dislocated surgically and left to develop in the dislocated position to determine the nature and timing of changes in the hip. Using the left hips as controls, 15 survivors were killed and studied macroscopically and microscopically at two months of age and 14 at four mon...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-11-01 00:00:00
abstract::Increased attention and resources focused on women's health during the past decade have resulted in new offices, policies, and programs of the Federal government. The Office of Research on Women's Health, established by the National Institutes of Health in 1990, is a focal point for all National Institutes of Health-s...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200003000-00003
更新日期:2000-03-01 00:00:00
abstract::A case of isolated dislocation of the pisiform occurred in an 18-year-old man who was treated by primary resection and followed for two years. As observed in previous reports, primary resection was a successful treatment. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1989-04-01 00:00:00
abstract:BACKGROUND:Although hip arthroplasty reliably relieves pain and improves function, problems have arisen with wear and osteolysis. Highly crosslinked polyethylene has been developed to address this problem although at present there is limited clinical evidence it does so longer term. QUESTIONS/PURPOSES:We compared the ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11999-010-1379-4
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:Revision TKA is a serious adverse event with substantial consequences for the patient. As the demand for TKA rises, reducing the risk of revision TKA is becoming increasingly important. Predictive tools based on machine-learning algorithms could reform clinical practice. Few attempts have been made to combin...
journal_title:Clinical orthopaedics and related research
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doi:10.1097/CORR.0000000000001343
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1984-11-01 00:00:00
abstract::Tuberculosis was first described in 1756 by Acrel in a case report. Subsequent reports of musculoskeletal tuberculosis documented the uncommon occurrence of hand and wrist involvement. The two cases presented here demonstrate the difficulty in eradicating the organism even with modern regimens of chemotherapy. Intraop...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-01-01 00:00:00
abstract::Eight patients with osteochondritis dissecans of the talus were reviewed. The average followup was 17.6 months (range, 8-26 months). The mean age of the patients was 31.8 years (range, 22-42 years). All patients had a preoperative examination, magnetic resonance imaging, and radiologic classification of the lesion thr...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200202000-00021
更新日期:2002-02-01 00:00:00
abstract::Contemporary knee designs differ considerably in the conformity that exists between the articulating surfaces of the femoral and tibial components. The thickness of the polyethylene components also varies from design to design. Conformity and thickness affect the stresses associated with surface damage and the subsequ...
journal_title:Clinical orthopaedics and related research
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更新日期:1995-08-01 00:00:00
abstract:BACKGROUND:Rotating-hinge total knee prostheses may be used for the treatment of global instability about the knee. The designs of previous generations were associated with suboptimal outcomes. QUESTIONS/PURPOSES:We evaluated the clinical and radiographic outcomes of salvage knee reconstructions using modern-generatio...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-009-1226-7
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abstract::To determine whether inappropriate surgical procedures based on an initial misdiagnosis affected recurrence and survival rates, we retrospectively reviewed the surgical treatment and results of 117 patients with high-grade osteosarcomas treated from January 1, 1990 to December 31, 2000. Nine patients had intralesional...
journal_title:Clinical orthopaedics and related research
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doi:10.1097/01.blo.0000229314.58878.88
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Patient-specific CT-based instrumentation may reduce implant malpositioning and improve alignment in TKA. However, it is not known whether this innovation is an advance that benefits patients. QUESTIONS/PURPOSES:We evaluated (1) the precision of patient-specific TKA by comparing the incidence of outliers in...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11999-013-3206-1
更新日期:2013-12-01 00:00:00
abstract::In 63 anatomic specimens of the shoulder, the coracohumeral ligament was found to be a clear, well-developed structure in 59 and absent or vestigial in four. The origin of the coracohumeral ligament was consistently found at the base of the coracoid process. The insertion was more variable, between the rotator interva...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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更新日期:1992-07-01 00:00:00
abstract::Glucocorticoid injection is widely used in tendon disorders. Despite previous studies on the histologic and biomechanical changes in tendons after glucocorticoid injections, the role of glucocorticoid in tendon rupture still is controversial. It was hypothesized that glucocorticoid has a direct deleterious effect on h...
journal_title:Clinical orthopaedics and related research
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更新日期:2004-04-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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更新日期:1986-08-01 00:00:00