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Abstract

Introduction: 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. Methods: 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. Results: TKR patients included 1326 younger (
University of Massachuses Medical School
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Research Retreat
2013 UMass Center for Clinical and Translational
Science Research Retreat
May 8th, 12:30 PM - 1:30 PM
Clinical Prole and Disability Levels of Younger vs.
Older TKR and THR Patients in a National
Research Consortium
David C. Ayers
University of Massachuses Medical School, David.Ayers@umassmemorial.org
Leslie R. Harrold
University of Massachuses Medical School, Leslie.Harrold@umassmed.edu
Benjamin Snyder
University of Massachuses Medical School, benjamin.snyder@umassmemorial.org
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David C. Ayers, Leslie R. Harrold, Benjamin Snyder, Sharina D. Person, and Patricia D. Franklin, "Clinical Prole 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.
hp://escholarship.umassmed.edu/cts_retreat/2013/posters/76
Presenter Information
David C. Ayers, Leslie R. Harrold, Benjamin Snyder, Sharina D. Person, and Patricia D. Franklin
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UMCCTS 2013
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: david.ayers@umassmemorial.org
Introduction:
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.
Methods:
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.
Results:
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.
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Full-text available
Unlabelled: Previous projections of total joint replacement (TJR) volume have not quantified demand for TJR surgery in young patients (< 65 years old). We developed projections for demand of TJR for the young patient population in the United States. The Nationwide Inpatient Sample was used to identify primary and revision TJRs between 1993 and 2006, as a function of age, gender, race, and census region. Surgery prevalence was modeled using Poisson regression, allowing for different rates for each population subgroup over time. If the historical growth trajectory of joint replacement surgeries continues, demand for primary THA and TKA among patients less than 65 years old was projected to exceed 50% of THA and TKA patients of all ages by 2011 and 2016, respectively. Patients less than 65 years old were projected to exceed 50% of the revision TKA patient population by 2011. This study underscores the major contribution that young patients may play in the future demand for primary and revision TJR surgery. Level of evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.