Should Chronological Age be a Consideration in Patients Undergoing Elective Primary Total Knee Arthroplasty?

BACKGROUND: The optimal time for total knee arthroplasty (TKA) requires a balance between patient disability and health state to minimize complications. While chronological age has not been shown to be predictive of complications in elective surgical patients, there is a point beyond which even optimized elderly patients would be at increased risk for complications. The purpose of this study was to examine the impact of chronological age on complications following primary TKA. METHODS: Using an administrative database, the records of 2,129,191 patients undergoing elective unilateral TKA between 2006 and 2021 were reviewed. The primary outcomes of interest were cardiac and pulmonary complications, and their relationship to the Charlson-Deyo Comorbidity Index (CDI) and chronological age. Secondary outcomes included risk of renal, neurologic, infection, and intensive care utilization postoperatively. The results were analyzed using a graphical method. The impact of chronological age as a modifier of overall risk for complications was modeled as a continuous variable. An age cutoff threshold of 80 years was also assigned for clinical convenience. RESULTS: The risk of complications correlated more closely to the CDI (odds ratio (OR) 1.37 to 2.1) than chronological age (OR 1.0 to 1.1) across the various complications [Table 1. However, beyond age 80 years, the risks of cardiac, pulmonary, renal, and cerebrovascular complications were significantly increased for all CDI categories (OR 1.73 to 3.40) compared to patients below age 80 years [Table 2] [Figures 1A and 1B]. CONCLUSIONS: Chronologic age can impact the risk of complications even in well-optimized elderly patients undergoing primary TKA. As arthroplasty continues to transition to outpatient settings and inpatient denials increase, these results can help patients, physicians, and payors mitigate risk while optimizing the allocation of resources.

The accuracy of Cameriere methods in Turkish children: chronological age estimation using developing teeth and carpals and epiphyses of the ulna and radius.

The aim of the present study was to develop a specific formula by measuring the developing teeth, carpal bones, and epiphyses of the ulna and radius to determine the chronological age in Turkish children. The left developing permanent mandibular teeth were evaluated, and the number of teeth with closed apex was recorded. The distance between the inner sides of open apex/apices was measured by using the ImageJ program and divided by the tooth length. The sum of the normalized open apices was also calculated. The carpal area (Ca), covering the epiphyses of ulna and radius and the carpal bones, was measured on the X-rays of left hand. The areas of each carpal bone and epiphyses of the ulna and radius were measured, and these measurements were added together to obtain the bone area (Bo). The Bo/Ca ratio between the total area of carpal bones and the carpal area was calculated to normalize the measurements. The accuracy of the equations formulated by Cameriere was evaluated, and a new regression equation was developed accordingly. The new formula showed no statistically significant difference between the chronological and the estimated age for females, males, and total sample. The new formula, which hit the age with 72.80% accuracy, was more successful in predicting chronological age than other adjusted regression equations. The new regression model, created for the Turkish children by using both developing teeth and hand-wrist bones, was considerably successful in estimating the chronological age.

Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool.

PURPOSE: To develop a simplified, modified frailty index for adult spinal deformity (ASD) patients dependent on objective clinical factors. METHODS: ASD patients with baseline (BL) and 2-year (2Y) follow-up were included. Factors with the largest R2 value derived from multivariate forward stepwise regression were including in the modified ASD-FI (clin-ASD-FI). Factors included in the clin-ASD-FI were regressed against mortality, extended length of hospital stay (LOS, > 8 days), revisions, major complications and weights for the clin-ASD-FI were calculated via Beta/Sullivan. Total clin-ASD-FI score was created with a score from 0 to 1. Linear regression correlated clin-ASD-FI with ASD-FI scores and published cutoffs for the ASD-FI were used to create the new frailty cutoffs: not frail (NF: < 0.11), frail (F: 0.11-0.21) and severely frail (SF: > 0.21). Binary logistic regression assessed odds of complication or reop for frail patients. RESULTS: Five hundred thirty-one ASD patients (59.5 yrs, 79.5% F) were included. The final model had a R2 of 0.681, and significant factors were: < 18.5 or > 30 BMI (weight: 0.0625 out of 1), cardiac disease (0.125), disability employment status (0.3125), diabetes mellitus (0.0625), hypertension (0.0625), osteoporosis (0.125), blood clot (0.1875), and bowel incontinence (0.0625). These factors calculated the score from 0 to 1, with a mean cohort score of 0.13 ± 0.14. Breakdown by clin-ASD-FI score: 51.8% NF, 28.1% F, 20.2% SF. Increasing frailty severity was associated with longer LOS (NF: 7.0, F: 8.3, SF: 9.2 days; P < 0.001). Frailty independently predicted occurrence of any complication (OR: 9.357 [2.20-39.76], P = 0.002) and reop (OR: 2.79 [0.662-11.72], P = 0.162). CONCLUSIONS: Utilizing an existing ASD frailty index, we proposed a modified version eliminating the patient-reported components. This index is a true assessment of physiologic status, and represents a superior risk factor assessment compared to other tools for both primary and revision spinal deformity surgery as a result of its immutability with surgery, lack of subjectivity, and ease of use.

Characterizing the Heterogeneity of Aging: A Vision for a Staging System for Aging.

Introduction: Older adulthood encompasses several decades of change and heterogeneity. Primary care providers need a geriatric comprehensive vision for defining older adult subpopulations. Methods: Using PubMed and Google searches, we reviewed the literature on epidemiology of age-related physiological changes, age-related diseases and geriatric syndromes, functional state, and emotional and social changes. We divided old age into strata based on chronological age and strata based on functional state, disease burden, and geriatric syndromes. Results: We describe 4 chronological-age strata beginning at age 60, and 4 functional-age strata based on frailty according to a modified clinical frailty scale. We provide clinical considerations and anticipatory guidance topics for each of the age strata and functional strata. Conclusion: Chronological age, functional status, chronic disease burden and geriatric syndromes, and life expectancy are all important domains that impact clinical care and appropriate anticipatory guidance for individual older adults. Better knowledge for differentiating subpopulations of older adults may improve clinical care, reduce medical overuse, improve personalized anticipatory guidance, and focus on the impact of functional state on the quality of life.

Comparison of Cameriere's and Demirjian's methods of age estimation among children in Kerala: a pilot study.

The aim was to compare age estimation using Cameriere's and Demirjian's methods to chronologic age in children with mixed dentition in a rural population of Kerala. The present study comprised of 10 subjects of age range 7-12 years. Dental age was assessed using Cameriere's and Demirjian's methods and was compared to the chronologic age. Panoramic radiographs were used for assessment of dental age. Data were analysed using paired t-test. The mean of difference obtained was 0.92 and the pvalue was 0.172 which showed insignificant difference between the two methods. Cameriere's method showed a positive linear correlation (0.6393) with chronologic age and was statistically significant (P=0.0171), whereas Demirjian's method showed a negative correlation (-0.7598) and was statistically insignificant (P=0.9967). The present study indicated that Cameriere's method is reliable for age estimation in our population and is more accurate than Demirjian's method.

The reliability of the Greulich and Pyle atlas when applied to a Southern Turkish population.

OBJECTIVE: The aim of this study was to evaluate the applicability of Greulich and Pyle (GP) method for Southern Turkish population. MATERIALS AND METHODS: Hand and wrist radiographs of 535 patients (276 females, 259 males aged from 10 to 18 years) selected retrospectively from the archive. Skeletal age (SA) estimation was performed according to GP atlas. The chronological age (CA) and SA were compared using the Paired t-test. RESULTS: The mean difference between the CA and SA ranged from 0.07 to 1.11 years. These differences between the CA and estimated SA were statistically significant in group I (10-10.90 years) (P < 0.001), group II (11-11.90 years) (P < 0.050), group III (12-12.90 years) (P < 0.001), group IV (13-13.90 years) (P < 0.010), and group V (14-14.90 years) (P < 0.001) for females. The mean difference between the CA and SA ranged from -0.41 to -1.79 years for females. These differences between the CA and estimated SA were statistically significant in all age groups. CONCLUSIONS: Statistically significant differences were found in the CA and SA assessed by GP method for the Southern Turkish sample. SA was significantly over-predicted in the 10-15 year ages in males and for 10-18 year ages for females. It is appropriate to use GP method in Southern Turkish children; however, a revision is needed for better results and to minimize the mistakes.

Biological Maturation, Body Morphology and Physical Performance in 8-16 year-old obese girls from Montes Claros - MG.

Measurements of maturity depend on the biological system considered since differences are often found in performance and body size in subjects of the same chronological age. The objective of this study was to identify associations between biological maturation, body morphology and physical performance in girls aged from 8.0 to 15.9 year-old and to verify the bone age in obese girls and compare it with chronological age. For that purpose 2040 (11.9 ± 2.3 years) school girls from Montes Claros, participated in this study. Regular anthropometric measures as height and body mass were taken. Triceps, biceps, subscapular, abdominal, suprailiac and calf skinfolds were also registered. Physical performance was assessed trough the test of a standing long jump, handgrip strength and 20 m multistage shuttle run. Maturational status, the average age at menarche and identification of PHV (maturity off set) were determined by means of the retrospective method. Girls with the BMI above the 95th percentile got their bone age evaluated through X-ray of the left hand/wrist, in accordance with the FELS method. It was possible to find an average age at menarche of 11.30 ± 0.70, while the average age at PHV was 12.17 ± 0.71 years of age. It was observed that both body composition and physical performance showed a tendency to increase with advancing age. However, when controlling the effect of maturation, despite having higher values in body composition the post-menarche girls group did not show higher levels of physical performance. In all age groups, obese girls showed mean rates of bone age higher than chronologic age (12.25 ± 2.09 and 14.09 ± 2.35, respectively, p=0.000). Chronological age should be used with caution when evaluating obese teenagers as it may underestimate biological age.

Evaluating the reliability of three different dental age estimation methods in visakhapatnam children.

UNLABELLED: Dental age is important for treatment planning in the specialities of pedodontics and orthodontics. Although, Demirjian's method was considered standard for dental age estimation, it may not be reliable for all population. AIM: The goal of the study was to evaluate the reliability of Demir-jian's, Haavikko's and Willems method of dental age estimation methods in Visakhapatnam (Andhra Pradesh, India) children. STUDY DESIGN: One hundred and two children of 6 to 14 years old who underwent panaromic digital radiography for routine diagnostic purposes were included. Dental age was calculated using Demirjian's, Haavikko's and Willems methods and compared with chronologic age for each patient. RESULTS: Dental age showed a significant overestimation by Demirjian's method with a mean difference of 0.55 year and underestimation by Haavikko's and Willems methods with a mean difference of 1.95 and 0.20 year respectively when compared with chronologic age. The mean difference between dental age and chronologic age was not significant in Willems method which shows a close relation between dental and chronologic ages. CONCLUSION: The dental age estimation by Willems method is found to be more accurate than Demirjian's and Haavikko's methods in Visakhapatnam children. How to cite this article: Patnana AK, Vabbalareddy RS, Vanga NRV. Evaluating the Reliability of Three Different Dental Age Estimation Methods in Visakhapatnam Children. Int J Clin Pediatr Dent 2014;7(3):186-191.

Correlación entre las edades cronológica y ósea en pacientes de ortodoncia / Correlation between the chronological and bone ages in orthodontics patients

Nos propusimos determinar la edad ósea según sexo y edad cronológica e identificar la relación existente entre las edades cronológica y ósea, en los pacientes estudiados. Se realizó un estudio descriptivo y transversal en un universo constituido por todos los niños y adolescentes tributarios de tratamiento ortodóncico, que ingresaron en la Clínica de Ortodoncia de la Facultad de Estomatología de la Universidad de Ciencias Médicas de La Habana, en el periodo de enero de 2004 a diciembre de 2006. El grupo etáreo se encontraba entre 8 y 16 años, de donde se seleccionó una muestra de 150 pacientes, mediante un muestreo por cuotas. A cada paciente se le realizó una radiografía de la mano izquierda, donde se determinó la edad ósea, a través del método de Tanner-Whitehouse 2 (TW2) y se calculó la correlación entre la edad ósea y la cronológica a través del coeficiente de correlación lineal de Pearson. Se encontraron correlaciones altas muy significativas entre las edades cronológica y ósea, en ambos sexos; sexo femenino r= 0,977 y masculino r= 0,983 (p< 0,010). La edad ósea de los pacientes calculada a través del método TW2, no coincidió con la edad cronológica, de manera que llegamos a la conclusión de que existe en ambos sexos, una correlación positiva alta entre las edades cronológica y ósea(AU)

To determine the bone age according to the sex and chronologic age and to identify the relation between the chronologic and bone ages in study patients. A cross-sectional and descriptive study was conducted in a universe including all children and adolescents needing orthodontics treatment admitted in the Orthodontics Clinic of the Stomatology Faculty of the Higher Institute of Medical Sciences (HIMS)-Habana from January, 2004 to December, 2006 aged between 8 and 16 selecting a sample including 150 patients by admission sampling, each patient undergoes a left hand radiography to determine the bone age by Tanner-Whitehouse 2 method (TW2) estimating the correlation between the bone age and chronologic one trough Pearson linear correlation coefficient. There were high and very significant correlations between the bone ages and the chronologic one in both sexes, female sex r= 0.977 and male sex r= 0.983 (p < 0.010). The bone age of patients estimated by TW2 method, not to coincided with the chronologic age and in both sexes there was a high positive correlation between above mentioned ages(AU)