Information Survey on the Use of Complementary and Alternative Medicine.

Background and Objectives: Complementary and alternative medicines (CAMs) are generally considered non-scientific and poor effective therapies. Nevertheless, CAMs are extensively used in common clinical practice in Western countries. We decided to promote a Delphi consensus to intercept the opinion of Italian physicians on CAM use in clinical practice. Materials and Methods: We run a Delphi-based consensus, interviewing anonymously 97 physicians. Of these, only 78 participate to the questionnaire. Results: Consensus about agreement and disagreement have been reached in several topics, including indication, as well as safety issues concerning CAMs. Conclusions: The use of CAMs in clinical practice still lacks evidence. Experts agree about the possibility to safely use CAMs in combination with conventional medicines to treat non-critical medical conditions.

Ticks and bacterial tick-borne pathogens in Piemonte region, Northwest Italy.

A molecular screening for tick-borne pathogens was carried out in engorged and in questing ticks collected in Verbano Cusio Ossola county, Piemonte region, Italy. Engorged ticks were removed from wild and domestic animal hosts. The most abundant and common tick species in the area was Ixodes ricinus (192 adults, 907 nymphs). Few individuals of Ixodes hexagonus (15) and Rhipicephalus sanguineus (7) were found among the ticks removed from domestic animals (46 examined ticks). The presence of Rickettsia spp., Borrelia burgdorferi sensu latu, Francisella tularensis and Coxiella burnetii was evaluated by PCR and sequencing in 392 individuals of I. ricinus (adult and nymphal stages) and 22 individuals of the two other tick species. Five Borrelia species (i.e. B. burgdorferi sensu stricto, B. garinii, B. afzelii, B. valaisiana and B. lusitaniae), proved or suspected to cause clinical manifestations of Lyme disease in humans, showed 10.5 and 2.2% combined prevalence in questing and engorged I. ricinus, respectively. In addition, two species of rickettsiae (R. helvetica and R. monacensis) were identified and reported with 14.5 and 24.8% overall prevalence in questing and in engorged ticks. The prevalence of F. tularensis in the ticks collected on two wild ungulate species (Capreolus capreolus and Cervus elaphus) was 5.7%. This work provided further data and broadened our knowledge on bacterial pathogens present in ticks in Northwest Italy.

Spread and genotype of Toxoplasma gondii in naturally infected alpine chamois (Rupicapra r. rupicapra).

The complex life cycle of Toxoplasma gondii involves many animal species, raising zoonotic, economic, and conservation issues. This complexity is reflected in the molecular structure of T. gondii, whose different genotypes differ in pathogenicity. Among the intermediate hosts of T. gondii, wild ungulates may be a source of human infection. Despite intense hunting activity and the consumption of raw or undercooked meat, little information is available on the spread of T. gondii and the distribution of its genotypes in these species, including the alpine chamois (Rupicapra r. rupicapra). Ninety-three sera and 50 brain tissues from chamois were sampled (1) to investigate the spread of T. gondii with serological and molecular analyses, and (2) to genotype the strains with a restriction fragment length polymorphism analysis of the SAG2 locus. The prevalence of T. gondii was low on both serological (3.2 %) and molecular (2 %) analyses, and infections were concentrated in individuals >1 year old. These findings demonstrate the sporadic presence of the protozoan in this species on consistent diagnostic tests. Horizontal transmission seems to be the main route of infection, and cats are the only definitive host in the study area. This prevalence suggests that the environment of the chamois is less contaminated with oocysts than environments close to human settlements. The SAG2 type II genotype was detected in this species for the first time. Although this genotype is predominant in human toxoplasmosis, these results suggest that the chamois is a minor source of human infection.

Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) and cardiovascular risk.

NSAIDs are largely used for the treatment of a huge variety of clinical conditions in order to relieve symptoms related to inflammation.The use of NSAIDs is associated with a potential increased risk of gastrointestinal and cardiovascular complications.The cardiovascular risk related to NSAIDs administration is often underestimated and it is frequently believed to be less important than the gastrointestinal risk. Adverse effects of NSAIDs are specifically related to their underlying mechanisms of action.The most plausible mechanism underlying the cardiovascular risk of NSAIDs has been identified in the profound inhibition of COX-2-dependent PGI2 in the presence of incomplete and intermittent inhibition of platelet COX-1. Nevertheless, the cardiovascular risk related to the use of NSAIDs is not only due to the COX-2 selectivity. An important determinant of the clinical effects of NSAIDs depends on the pharmacokinetic features of the different drugs such as half-life, and type of formulations, which can influence the extent and duration of patient exposure to COXisozyme inhibition. The aim of this review is to analyse the mechanisms behind the cardiovascular risk of different NSAIDs.

A systematic literature review of the Profix in primary total knee arthroplasty.

Despite more than a decade of use, there are currently no comprehensive reviews summarising clinical results with the Profix Total Knee System in primary total knee arthroplasty. Searching the PubMed and Google Scholar databases revealed 17 potentially relevant Profix manuscripts. After author review and exclusion of studies not meeting predetermined variables, 8 manuscripts were selected. Knee Society data were provided in all 8 and implant survival data in 4. Data for 987 patients (1152 knees) were available. The overall estimated implant survival was 98.6% at 5 years and 94.2% at 10 years with revision for any reason as an endpoint, and 100% at both time points with radiographic loosening as an endpoint. Mean/median preoperative Knee Society knee scores improved from 39.2/24.7 at baseline, to 91.4/92.1 at the last postoperative follow-up visit. Good medium-to long-term clinical results can be expected with the Profix in primary total knee arthroplasty.

A Multiple Emergency Ventilator as Backup Solution in Pandemic: A Specifically Designed and Dimensioned Device.

Goal: To provide a Multiple Emergency Ventilator (MEV) as backup in case of shortage of ICU ventilators and for use in camp hospitals. Methods: MEV provides the same oxygen mixture and peak inspiratory pressure (PIP) to 10 patients. These specifications were fixed: i) gas supply and plugs to double-limb intubation sets compatible to existing systems; ii) fluid-dynamics with no pressure drop and almost complete patients' uncoupling; iii) individual monitoring of inspiratory and expiratory pressures and flows and control of their timing; iv) easy stocking, transport, installation with self-supporting pipes. Results: A Bell-Jar System (BJS) design permitted to safely fix PIP based on Archimedes' law. The main distribution line was based on 2" stainless steel pipes assuring the required mechanical properties and over-dimensioned for fluidics. The Windkessel of the BJS and pipeline dead-volumes is 75.65 L and in the worst case of the instantaneous demand of 5 L by 10 patients (0.5 L each) shows an adiabatic PIP drop limited to -6.18%, confirming the needed uncoupling. Consequently, patients' asynchrony is permitted as needed by pressure-controlled volume-guaranteed and assisted-ventilation. Conclusions: Although MEV is proposed as a backup system, its features may cover the whole set of ventilation modes required by ICU ventilation.

Unintentional Recovery of Parasitic Diversity Following Restoration of Red Deer (Cervus elaphus) in North-Western Italy.

Red deer (Cervus elaphus) populations in north-western Italy have been remodeled in recent decades. Multiple translocations and the spontaneous migration from Switzerland and France resulted in the successful redistribution of the red deer after human-driven extirpation during the 18th century. The scarcely diverse parasitic community harbored by these cervids has been enriched with two species-specific taxa, Onchocerca jakutensis and Phayigomyia picta, suggesting that the recovery of parasitic biodiversity could be included amongst future conservation goals of this intensively managed game. Nodular onchocercosis was reported in three red deer populations since 2011, while nasal bots were reported since 2018. Hypoderma spp. larvae were identified for the first time in 1989, then a second record was made in 2014 in the province of Biella, where a yearling male in poor condition infested with Hypoderma diana was observed. In the perspective that the restoration of species-specific parasite communities of native mammals in Europe is increasingly perceived as a conservation target, with similar dignity as the conservation of their hosts, baseline data presented in this communication may give new insights for future parasite conservation efforts.

Disentangling Individual Phases in the Hunted vs. Farmed Meat Supply Chain: Exploring Hunters' Perceptions in Italy.

The growing body of literature concerning the hunted wild game meat (HWGM) supply chain is mainly focused on the final consumer, while little is known about upstream production processes. Even though the hunter plays a central role here, it is not well understood how hunters themselves perceive their role in the various phases of the production process. The present study explores Italian hunters' perception of the HWGM supply chain and compares it to their perception towards the conventional farmed meat supply chain. We distinguish several phases of this production process and find that the final phase related to on-site game dressing is considered problematic, perhaps because hunters perceive themselves as less skilled than professional butchers. The results, in fact, show that hunters prefer hunted products over farmed meat, but that they consider hunted wild boar meat less safe compared to farmed pork. Findings from this study provide a rare glimpse from the inside of the supply chain and reveals the needs for a broad risk assessment analysis on the Italian game meat supply chain. Considering the development of the Italian emerging market of the HWGM, our results also highlight the relevance of training activities on hunters in order to increase the safety and quality of the final product.

Early Joint Replacement in Juvenile Idiopathic Arthritis: Trend Over Time and Factors Influencing Implant Survival.

OBJECTIVE: To describe early prosthesis implantations in a cohort of patients with juvenile idiopathic arthritis (JIA) followed in a tertiary referral hospital and to analyze possible factors influencing implant survival. METHODS: This was a retrospective cohort study. Charts of all patients with JIA who underwent total joint replacement at Gaetano Pini Hospital, Milan, Italy from January 1992 to June 2019 were retrieved, and relevant data were analyzed. RESULTS: Eighty-five patients met the inclusion criteria for this study, with a median follow-up period of 17.2 years. The median age at first prosthesis was 22.7 years. The total number of replaced joints was 198 over a period of 27 years. The hip was the most frequently replaced joint, accounting for almost two-thirds of the total number of implants; the other one-third refers mostly to knee implants. Polyarticular JIA and systemic JIA were the most represented JIA categories in the study cohort. A significant upward trend of the age at arthroplasty and of disease duration before arthroplasty over decades was found. The rates of implant survival at 5, 10, and 15 years were comparable (from 84% to 89%); 50% of implants lasted ≥20 years. CONCLUSION: We reported retrospective data on early joint replacement in a cohort of patients with JIA. We observed a progressive and significant upward trend of both age at arthroplasty and disease duration before the first arthroplasty over time. The JIA category, year of implant, and presence of complications significantly affected implant survivorship.

Detection of Zoonotic Cryptosporidium ubiquitum in Alpine Wild Ruminants.

Cryptosporidium is a widespread apicomplexan protozoan of major zoonotic importance, characterized by a wide host range, and with relevant economic implications and potential negative effects on livestock and wildlife population dynamics. Considering the recent strong demographic increase of alpine ungulates, in this study, carried out in the Italian Northwestern Alps, we investigated the occurrence of Cryptosporidium spp. in these species and their potential involvement in environmental contamination with Cryptosporidium spp. oocysts. The immune-enzymatic approach revealed a Cryptosporidium prevalence of 1.7% (5/293), 0.5% (1/196) and 3.4% (4/119) in alpine chamois (Rupicapra rupicapra), red deer (Cervus elaphus) and roe deer (Capreolus capreolus), respectively. Positive samples were subjected to polymerase chain reaction (PCR) amplification for the COWP and gp60 genes. The presence of Cryptosporidium was confirmed in one chamois and four roe deer. Sequences obtained clustered within Cryptosporidium ubiquitum, currently recognized as an emerging zoonotic species. This finding represents the first detection of zoonotic C. ubiquitum in chamois and in the Alpine environment. Despite the low observed prevalences, environmental contamination by oocysts could play a role as a potential source of infections for humans and livestock.

Low Serologic Prevalences Suggest Sporadic Infections of Hepatitis E Virus in Chamois (Rupicapra rupicapra) and Red Deer (Cervus elaphus) in the Italian Alps.

Hepatitis E virus (HEV) is a worldwide public health concern, with an increase in human autochthonous cases in Europe. Although domestic pigs and wild boar (Sus scrofa) are the main reservoirs of HEV, the constant expansion of wild ruminants increases the potential for HEV transmission. We investigated HEV infection in chamois (Rupicapra rupicapra) and red deer (Cervus elaphus) in the Italian Alps using an enzyme-linked immunosorbent assay (ELISA). We detected HEV antibodies from 2013 to 2015 in both host species, with seroprevalences of 1.2% and 0.8% in chamois and red deer, respectively. All serum samples that were positive to HEV antibodies by ELISA were negative when tested by real-time reverse-transcriptase PCR to detect HEV RNA. The observed low seroprevalence of HEV suggested a sporadic circulation of HEV in the alpine environment, and it was consistent with the low seroprevalence observed in wild boar in the Alps. Our observations supported the role of chamois and red deer as spillover hosts of HEV infections in the Italian Alps.

Host range of mammalian orthoreovirus type 3 widening to alpine chamois.

Mammalian orthoreoviruses (MRV) type 3 have been recently identified in human and several animal hosts, highlighting the apparent lack of species barriers. Here we report the identification and genetic characterization of MRVs strains in alpine chamois, one of the most abundant wild ungulate in the Alps. Serological survey was also performed by MRV neutralization test in chamois population during five consecutive years (2008-2012). Three novel MRVs were isolated on cell culture from chamois lung tissues. No respiratory or other clinical symptoms neither lung macroscopic lesions were observed in the chamois population. MRV strains were classified as MRV-3 within the lineage III, based on S1 phylogeny, and were closely related to Italian strains identified in dog, bat and diarrheic pig. The full genome sequence was obtained by next-generation sequencing and phylogenetic analyses showed that other segments were more similar to MRVs of different geographic locations, serotypes and hosts, including human, highlighting genome reassortment and lack of host specific barriers. By using serum neutralization test, a high prevalence of MRV-3 antibodies was observed in chamois population throughout the monitored period, showing an endemic level of infection and suggesting a self-maintenance of MRV and/or a continuous spill-over of infection from other animal species.

Quality parameters of hunted game meat: Sensory analysis and pH monitoring.

The aim of the present research is to propose a new, quick and objective method for the certification of hunted and/or culled wild game meat quality and to monitor its origin and the hunting practices adopted by hunters. The expected deliverable is a new labelling scheme for Italian hunted wild game meat that will guarantee high quality and safety standards for consumers and will decrease transaction costs of the supply chains. During the 2015, 2016 and 2017 hunting seasons, 1,056 hunted wild ungulates were sampled. Specifically, alpine chamois (n=537), roe deer (n=113), red deer (n=342) and wild boar (n=64), which were all hunted in the VCO2-Ossola Nord hunting district (Verbania Province, Piedmont, Italy). Samples of the longissimus dorsi were collected to evaluate the nutritional parameters and the acid profiles of the products. As a measure of meat quality, pH values have been recorded after slaughtering by inserting a probe in the semimembranosus muscle. The results were categorized as DFD (pH≥6,2), intermediate DFD (5,8≤pH<6,2) and high-quality meat (pH <5,8). As explanatory variables for the quality of wild game meat, differences based on age, gender and hunting practices were considered. Concerning the latter variables, measures were collected from animals received at hunting districts control centers by trained technicians who also collected information on the hunting practices, i.e., bleeding and evisceration of the carcasses and number of shots. Nutritional values showed low fat (<3 g per 100 g), low saturated fat (<1,5 g per 100 g) and high protein contents. Furthermore, wild game meat has high values of ω3 and CLA, ensuring a positive ω6/ω3 ratio. Differences were found in the concentrations of fat between age and gender, considering that during the mating season, adult males' weight loss can exceed 40%. Hunting practices seem to affect meat quality.

Presence of organic halogenated compounds, organophosphorus insecticides and polycyclic aromatic hydrocarbons in meat of different game animal species from an Italian subalpine area.

The exposure to several compounds such as polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), organophosphorus pesticides (OPs), polycyclic aromatic hydrocarbon (PAHs), perfluoroalkyl substances (PFASs) and polybrominated diphenyl ethers (PBDEs) is a public health issue. The European Union (EU) recommended that its member states monitor the presence of emerging contaminants, like PBDEs and PFASs, in food and in the environment to obtain an accurate estimation of exposure. The tissues of wild animals exposed to these compounds can represent a suitable indicator of environmental pollution. The aim of this work is to evaluate: (i) the occurrence of PCBs, PBDEs, PFASs, PAHs, OCPs and OPs in four game animals' meat (chamois, red deer, wild boar and roe deer); (ii) interspecies differences and (iii) human exposure. Muscle samples from seventy-nine animals were collected during the hunting season in a Northern Italy mountain area at altitudes ranging from 300 to 2500 meters above sea level. The analyses were performed with gas chromatography-mass spectrometry (GC-MS/MS) and ultra-performance liquid chromatography - tandem mass spectrometry (UHPLC-MS/MS). No PBDEs were found in the samples. OCPs, OPs and PCBs were detected in almost all samples at different concentration ranges, showing higher frequency in ungulate species than in wild boar. PFAs were found only in wild boar. Anthracene and benzopyrene, among PAHs, were found only in chamois, at low concentrations. The lack of an accurate pattern of exposure as well as variable consumption by hunters does not allow accurate risk characterisation. However, a low risk for consumers can be indicated due to the frequent detection of contaminants only at trace levels, the scarce prevalence of high concentrations of some contaminants and the low consumption of game animal meat. In conclusion, the organisation of a control plan on residues in game animals would be advisable.

Clinical results of bone ingrowth TKA in patients with rheumatoid arthritis.

UNLABELLED: Patients with rheumatoid arthritis (RA) often are not considered for TKA with bone ingrowth fixation because of poor bone quality, but we asked whether implants with sintered metal bead surfaces could be used to durably fix implants in this group of patients. We prospectively evaluated a consecutive series of 47 patients (64 knees) between January 1, 1994, and December 30, 2001, in two separate medical centers using one TKA system. Standard primary implants were used in all knees except those with major bone defects, and in these patients we used long diaphyseal stems to stabilize the implants. Minimum followup was 61 months (mean +/- standard deviation, 83 +/- 6 months; range, 61-124 months). Survivorship was 98.4% at 10 years postoperatively. No components failed because of loosening. One femoral component was revised for fracture because of a massive intraosseous rheumatoid cyst. No knees had radiographic evidence of migration or widening radiolucent lines. Knee Society clinical, pain, and function scores improved after surgery and were maintained throughout followup. These data suggest bone ingrowth implants can provide durable fixation in patients with RA. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Consumer preferences for red deer meat: a discrete choice analysis considering attitudes towards wild game meat and hunting.

This study aims to analyse consumer preferences for red deer meat (RDM) (Cervus elaphus) by conducting a case study in northern Italy. This analysis considers how the attitudes of consumers towards wild game meat and hunting might influence such preferences. This goal is achieved by combining the results of a k-means clustering analysis of the attitudes collected by means of two valuation scales with a discrete choice experiment (CE). According to our results, a positive attitude towards wild game meat has an effect on the willingness to pay (WTP) for RDM that is more than 3 times greater than being in favour of hunting. An analysis of the heterogeneity of consumer preferences allowed us to identify the presence of an important niche market for RDM served as carpaccio. Examining only the mean estimates for carpaccio without considering heterogeneity would lead to neglecting 18% of the sample with a positive willingness to pay for this attribute level.

Good mid- to long-term THA outcomes with a modified cementless rectangular biconical stem design.

PURPOSE: Second- and third-generation cementless Zweymüller stems have achieved good long-term outcomes in total hip arthroplasty (THA). The PPF cementless proximal press-fit femoral stem (Biomet Inc.) is based on the Zweymüller stem, with some prominent design differences. This study was designed to assess its performance in terms of survivorship, clinical function, and radiographic outcomes. METHODS: We retrospectively analysed 250 patients (303 hips) who underwent THA between 1998 and 2011. Patients attended a follow-up visit a mean 10.9 ± 2.6 years after the procedure. All patients underwent radiographic examination and were clinically assessed for Forgotten Joint Score (FJS) and pain visual analogue scale (VAS). Survivorship was calculated using Kaplan-Meier analysis. RESULTS: Clinical data were available for 142 patients (192 hips) and radiographic data for 79 patients (109 hips). Stem survival was 99.1% (95% confidence interval [CI] 96.6%-99.8%) at 10 years and 95.6% (95% CI 96.6%-99.8%) at 15 years. The median postoperative FJS was 91 (interquartile range [IQR], 75-100). The median VAS score was 0 (IQR, 0-2). Radiolucent lines were observed in 47 hips (43.1%). 25 hips (22.9%) had Grade I ossification, 17 (15.6%) Grade II, and 2 (1.8%) Grade III. 12 hips (11.0%) had osteolysis in at least 1 femoral zone. CONCLUSIONS: The cementless proximal press-fit femoral stem was associated with good mid- to long-term survival and functional outcomes. The current design can be considered equivalent to the second- and third-generation Zweymüller stems.

Clonal diversity, virulence-associated genes and antimicrobial resistance profile of Staphylococcus aureus isolates from nasal cavities and soft tissue infections in wild ruminants in Italian Alps.

Staphylococcus aureus is a commensal and a pathogenic bacterium that causes a wide variety of diseases in humans and animals with a high impact on public health and the livestock industry. S. aureus virulence pattern, antimicrobial resistance profile and host specialization are of great concern both in livestock and in companion animals. Concerning wild animals, S. aureus carriage and antimicrobial resistance profile has been recently investigated in free-ranging species both in aquatic and terrestrial environment. Here we report genotyping (spa typing, Multilocus Sequence Typing and SCCmec typing), virulence and antimicrobial resistance profile of four S. aureus isolated in Alpine chamois (Rupicapra r. rupicapra) and roe deer (Capreolus capreolus), euthanized due to walking impairment and signs of disorientation. S. aureus was isolated from nasal cavities in both wild ruminant species and in soft tissue infections in chamois. A marked S. aureus genetic heterogeneity was detected: spa type t1523, sequence type 45 (Clonal Complex 45), and spa type t1328, ST22 (CC22) from the nasal cavities and the liver of a chamois kid respectively, t1773, ST700 (CC130) from an adult chamois abscess, and a new sequence type, ST2712, belonging to CC97 from the roe deer nasal cavities. One of the main findings was the confirmation that the t1328, ST22 isolate, obtained from the liver of the chamois kid, was a methicillin-resistant S. aureus (MRSA) harbouring a SCCmec cassette type IV. The set of virulence marker and toxin genes investigated showed profiles characteristic of the S. aureus lineages detected, including those of the human adapted ST (CC) 22 and ST (CC) 45 isolates.

The SIPI for measuring complexity in nursing care: evaluation study.

BACKGROUND: The traditional model for nursing staff management widely used in Italian hospitals assumes that diagnosis determines the amount of nursing required, but this has been widely criticized. In order to quantify and monitor the fluctuation of the complexity in nursing care, a questionnaire, called SIPI (Sistema Informativo della Performance Infermieristica), that is based on the care needs expressed by the patients, has been proposed in the Monza Hospital. DESIGN: A group of trained nurses were asked to indicate their own perception of the level of nursing day-care complexity provided to each patient and then to complete the SIPI. SETTINGS: The Monza Hospital coordinated this multi-centre study that involved 25 Hospitals of North Italy. PARTICIPANTS: Each hospital contributed with a minimum of three units, at least one for each area of intensity of clinical care, as defined by health regulators. All adult in-patients being in the units from at least 24h were included in the survey. Psychiatric wards, neonatology, intensive and semi-intensive care wards were non considered. METHODS: A group of nurses trained with the use of SIPI completed the questionnaires based on the nursing file of performed activities. Before filling the questionnaire, the nurses were asked to indicate their perception of the level of complexity of the day-care provided to each patient. In order to calculate the SIPI scores that discriminate different nurse complexity levels, a ROC analysis and the multinomial logistic regression model were used, considering the perceived complexity as the standard of reference. RESULTS: The nursing day-care complexity was measured in 115 wards, for a total of 17,803 completed questionnaires. Nursing complexity was roughly the same in areas of different intensity of clinical care, both according to perception and as measured by SIPI. A cut-off of 49.2 was identified as optimal to distinguish two classes of complexity with a good performance (80% of specificity, 85% of sensitivity). CONCLUSIONS: The SIPI was shown to be a simple and useful tool that may be adopted in the future for an optimal allocation of nursing resources. The results of this study confirmed that elevated intensity of care from the clinical perspective does not necessarily correspond to high nursing complexity.

Young and heavy patients with a cementless TKA do as well as older and lightweight patients.

UNLABELLED: Given concerns about long term implant loosening in young, heavy patients, we asked whether these patients would fare as well as older, lightweight patients with bone-ingrowth fixation. Cementless total knee arthroplasty was performed consecutively in 1328 patients (1556 knees) using a total knee system designed for porous-ingrowth fixation. A consecutive series of 122 patients (167 knees) whose age was younger than 55 years and whose weight was greater than 90 kg was compared with a gender-matched consecutive series of 122 patients (167 knees) who were 65 years of age or older and who weighed less than 80 kg. The minimum followup was 5 years (mean 7.3 years; range 5-10 years). The mean Knee Society scores and pain scores were similar at each interval for both groups. Function scores were better for the young, heavy patients at each interval. None of the knees in either group loosened. One patient in the young, heavy group underwent polyethylene component revision for wear. These results indicate young, heavy patients fare as well as older, lightweight patients when this implant is used with the osteointegration technique. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.