University of Massachuses Medical School
UMass Center for Clinical and Translational Science
2013 UMass Center for Clinical and Translational
Science Research Retreat
May 8th, 12:30 PM - 1:30 PM
Clinical Prole and Disability Levels of Younger vs.
Older TKR and THR Patients in a National
David C. Ayers
University of Massachuses Medical School, David.Ayers@umassmemorial.org
Leslie R. Harrold
University of Massachuses Medical School, Leslie.Harrold@umassmed.edu
University of Massachuses Medical School, firstname.lastname@example.org
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David C. Ayers, Leslie R. Harrold, Benjamin Snyder, Sharina D. Person, and Patricia D. Franklin, "Clinical Prole and Disability Levels
of Younger vs. Older TKR and THR Patients in a National Research Consortium" (May 8, 2013). UMass Center for Clinical and
Translational Science Research Retreat. Paper 76.
David C. Ayers, Leslie R. Harrold, Benjamin Snyder, Sharina D. Person, and Patricia D. Franklin
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Clinical Profile and Disability Levels of Younger vs. Older TKR and THR Patients in a
National Research Consortium
David C. Ayers1, MD ; Leslie Harrold1, MD, MPH; Benjamin Snyder1, MD MS; Sharina Person2,
PhD; Patricia D. Franklin1, MD, MBA, MPH
UMass Medical School departments of 1Orthopedics and Physical Rehabilitation and
2Quantitative Health Sciences
Corresponding Author: David C. Ayers, MD
The Arthur Pappas Professor and Chair, Department of Orthopedics and Physical Rehabilitation,
Director, Musculoskeletal Center of Excellence and The Arthritis and Joint Replacement Center
Department of Orthopedics and Physical Rehabilitation, UMass Medical School
Phone: 508-856-5748 Email: email@example.com
A growing number of patients under 65 years old undergo total knee replacement (TKR) and
total hip replacement (THR).1 This trend has raised concerns that younger patients may receive
surgery prematurely. We examined demographic and clinical factors in younger versus older
patients in a national sample of THR and THR patients.
Patients undergoing primary TKR and THR from 7/1/11 through 12/03/12 were identified from a
national research consortium that gathers demographics, comorbid conditions (Charlson
Comorbidity Index), Short Form 36 Physical Component Score (PCS) and Mental Component
Score (MCS), burden of musculoskeletal disease using the Knee injury and Osteoarthritis
Outcome Score (KOOS) or the Hip injury and Osteoarthritis Outcome Score (HOOS) and the
Oswestry Low Back Pain Disability Questionnaire. Descriptive statistics were performed.
TKR patients included 1326 younger (<65) and 1988 older (≥65) patients. Younger patients
were more likely nonwhite (13.6% vs. 7.3%) and Hispanic/Latino (3.3% vs. 2.2%), with worse
functional impairment as measured by the PCS (32.14 vs. 33.0). Younger patients had fewer
comorbid conditions, but were heavier (mean BMI 33.0 vs. 30.5), smokers (9.4% vs. 2.6%), with
worse mental health (mean MCS 49.1 vs. 52.4).
THR patients included 1175 younger (<65) and 1245 older (≥65) patients. Younger patients
were more likely nonwhite (12.1% vs. 6%) and Hispanic/Latino (2.2% vs. 0.8%). Both had
substantial functional impairment with PCS of 31.2 and 31.4. Younger patients reported greater
operative hip joint pain and stiffness. Younger patients had fewer comorbid conditions but were
heavier (mean BMI 29.8 vs. 28.5), smokers (13.1% vs. 3.0%), with worse mental health (mean
MCS 48.4 vs. 51.5).
Conclusion: Younger patients have fewer medical illnesses at the time of TKR or THR, but
have greater functional impairment and higher rates of obesity and smoking as well as lower
mental health scores.
1. Kurtz, S. M., Lau, E., Ong, K., Zhao, K., Kelly, M., & Bozic, K. J. (2009). Future young patient demand for primary and revision joint
replacement: National projections from 2010 to 2030. Clinical Orthopaedics and Related esearch. 467(10):2606-12.