1
|
Wyatt MC, Frampton CF, Whitehouse MR, Deere KC, Sayers A, Kieser D. Benchmarking total knee replacement constructs using noninferiority analysis: the New Zealand joint registry study. BMC Musculoskelet Disord 2021; 22:721. [PMID: 34425821 PMCID: PMC8381520 DOI: 10.1186/s12891-021-04606-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the relative performance of total knee replacement constructs and discern if there is variability in performance in currently commonly used prostheses in the New Zealand Joint Registry (NZJR) using a noninferiority analysis. METHODS All patients who underwent a primary total knee replacement (TKR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of total knee replacement prostheses were compared with the best performing contemporary construct. Construct all-cause revision rate was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in all-cause revision rates between the contemporary benchmark and all other constructs was tested. RESULTS In total 110 183 TKR were recorded and 25 constructs (102 717 procedures) had > 500 procedures at risk at 3 years post-primary of which 5 were inferior by at least 20 % relative risk of which, one was inferior by at least 100 % relative risk. 14 constructs were identified with > 500 procedures at risk at 10 years with 5 inferior by at least 20 %, of which 2 were inferior by > 100 % relative risk. CONCLUSIONS We discerned that there is great variability in construct performance and at all time points, greater than 25 % of constructs are inferior to the best performing construct by at least 20 %. These results can help inform patients, clinicians and health care funders when considering TKR surgery.
Collapse
Affiliation(s)
- M C Wyatt
- Massey University, Palmerston North, New Zealand.
| | | | | | | | - A Sayers
- University of Bristol, Bristol, UK
| | - D Kieser
- University of Otago, Dunedin, New Zealand
| |
Collapse
|
2
|
Tobias JH, Sayers A, Deere KC, Heazell AEP, Lawlor DA, Ireland A. Breech presentation is associated with lower adolescent tibial bone strength. Osteoporos Int 2019; 30:1423-1432. [PMID: 31020365 DOI: 10.1007/s00198-019-04945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/18/2019] [Indexed: 12/28/2022]
Abstract
We compared bone outcomes in adolescents with breech and cephalic presentation. Tibia bone mineral content, density, periosteal circumference, and cross-sectional moment of inertia were lower in breech presentation, and females with breech presentation had lower hip CSA. These findings suggest that prenatal loading may exert long-lasting influences on skeletal development. INTRODUCTION Breech position during pregnancy is associated with reduced range of fetal movement, and with lower limb joint stresses. Breech presentation at birth is associated with lower neonatal bone mineral content (BMC) and area, but it is unknown whether these associations persist into later life. METHODS We examined associations between presentation at onset of labor, and tibia and hip bone outcomes at age 17 years in 1971 participants (1062 females) from a UK prospective birth cohort that recruited > 15,000 pregnant women in 1991-1992. Cortical BMC, cross-sectional area (CSA) and bone mineral density (BMD), periosteal circumference, and cross-sectional moment of inertia (CSMI) were measured by peripheral quantitative computed tomography (pQCT) at 50% tibia length. Total hip BMC, bone area, BMD, and CSMI were measured by dual-energy X-ray absorptiometry (DXA). RESULTS In models adjusted for sex, age, maternal education, smoking, parity, and age, singleton/multiple births, breech presentation (n = 102) was associated with lower tibial cortical BMC (- 0.14SD, 95% CI - 0.29 to 0.00), CSA (- 0.12SD, - 0.26 to 0.02), BMD (- 0.16SD, - 0.31 to - 0.01), periosteal circumference (- 0.14SD, - 0.27 to - 0.01), and CSMI (- 0.11SD, - 0.24 to 0.01). In females only, breech presentation was associated with lower hip CSA (- 0.24SD, - 0.43 to 0.00) but not with other hip outcomes. Additional adjustment for potential mediators (delivery method, birthweight, gestational age, childhood motor competence and adolescent height and body composition) did not substantially affect associations with either tibia or hip outcomes. CONCLUSIONS These findings suggest that prenatal skeletal loading may exert long-lasting influences on skeletal size and strength but require replication.
Collapse
Affiliation(s)
- J H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - K C Deere
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A E P Heazell
- Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, Bristol University, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - A Ireland
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK.
| |
Collapse
|
3
|
Piasecki J, McPhee JS, Hannam K, Deere KC, Elhakeem A, Piasecki M, Degens H, Tobias JH, Ireland A. Hip and spine bone mineral density are greater in master sprinters, but not endurance runners compared with non-athletic controls. Arch Osteoporos 2018; 13:72. [PMID: 29971503 PMCID: PMC6028830 DOI: 10.1007/s11657-018-0486-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/05/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED We examined bone density in older athletes and controls. Sprinters had greater hip and spine bone density than endurance athletes and controls, whereas values were similar in the latter two groups. These results could not be explained by differences in impact, muscle size or power between sprint and endurance athletes. PURPOSE We examined the relationship between prolonged participation in regular sprint or endurance running and skeletal health at key clinical sites in older age, and the factors responsible for any associations which we observed. METHODS We recruited 38 master sprint runners (28 males, 10 females, mean age 71 ± 7 years), 149 master endurance runners (111 males, 38 females, mean age 70 ± 6 years) and 59 non-athletic controls (29 males, 30 females, mean age 74 ± 5 years). Dual X-ray absorptiometry was used to assess hip and spine bone mineral density (BMD), body composition (lean and fat mass), whilst jump power was assessed with jumping mechanography. In athletes, vertical impacts were recorded over 7 days from a waist-worn accelerometer, and details of starting age, age-graded performance and training hours were recorded. RESULTS In ANOVA models adjusted for sex, age, height, body composition, and jump power, sprinter hip BMD was 10 and 14% greater than that of endurance runners and controls respectively. Sprinter spine BMD was also greater than that of both endurance runners and controls. There were no differences in hip or spine BMD between endurance runners and controls. Stepwise regression showed only discipline (sprint/endurance), sex, and age as predictors of athlete spine BMD, whilst these variables and starting age were predictive of hip BMD. CONCLUSIONS Regular running is associated with greater BMD at the fracture-prone hip and spine sites in master sprinters but not endurance runners. These benefits cannot be explained by indicators of mechanical loading measured in this study including vertical impacts, body composition or muscular output.
Collapse
Affiliation(s)
- J. Piasecki
- Sport, Health and Performance Enhancement Research Centre, Nottingham Trent University, Nottingham, UK
| | - J. S. McPhee
- Department for Sports and Exercise Sciences, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD UK
| | - K. Hannam
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - K. C. Deere
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A. Elhakeem
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - M. Piasecki
- MRC/ARUK Centre of Excellence for Musculoskeletal Ageing Research Centre, School of Medicine, University of Nottingham, Derby, UK
| | - H. Degens
- Department for Sports and Exercise Sciences, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD UK ,Institute of Sport Science and Innovations, Lithuanian Sports University, Lithuania, Lithuania
| | - J. H. Tobias
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A. Ireland
- Department for Sports and Exercise Sciences, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD UK
| |
Collapse
|
4
|
Hannam K, Deere KC, Hartley A, Al-Sari UA, Clark EM, Fraser WD, Tobias JH. Habitual levels of higher, but not medium or low, impact physical activity are positively related to lower limb bone strength in older women: findings from a population-based study using accelerometers to classify impact magnitude. Osteoporos Int 2017; 28:2813-2822. [PMID: 27966105 PMCID: PMC5624975 DOI: 10.1007/s00198-016-3863-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022]
Abstract
UNLABELLED This study assessed the effect of accelerometry-measured higher impacts resulting from habitual weight-bearing activity on lower limb bone strength in older women. Despite higher impacts being experienced rarely in this population-based cohort, positive associations were observed between higher vertical impacts and lower limb bone size and strength. INTRODUCTION We investigated whether the benefit of habitual weight-bearing physical activity (PA) for lower limb bone strength in older women is explained by exposure to higher impacts, as previously suggested by observations in younger individuals. METHODS Four hundred and eight women from the Cohort for Skeletal Health in Bristol and Avon (COSHIBA), mean 76.8 years, wore tri-axial accelerometers at the waist for a mean of 5.4 days. Y-axis peaks were categorised, using previously identified cutoffs, as low (0.5-1.0 g), medium (1.0-1.5 g), and higher (≥1.5 g) impacts. Mid and distal peripheral quantitative computed tomography scans of the tibia and radius were performed, as were hip and lumbar spine Dual X-ray Absorptiometry (DXA) scans. Regressions between (log transformed) number of low, medium and high impacts, and bone outcomes were adjusted for artefact error grade, age, height, fat and lean mass and impacts in other bands. RESULTS Eight thousand eight hundred and nine (4047, 16,882) low impacts were observed during the measurement week, 345 (99, 764) medium impacts and 42 (17, 106) higher impacts (median with 25th and 75th quartiles). Higher vertical impacts were positively associated with lower limb bone strength as reflected by cross-sectional moment of inertia (CSMI) of the tibia [0.042 (0.012, 0.072) p = 0.01] and hip [0.067 (0.001, 0.133) p = 0.045] (beta coefficients show standard deviations change per doubling in impacts, with 95 % confidence interval). Higher impacts were positively associated with tibial periosteal circumference (PC) [0.015 (0.003, 0.027) p = 0.02], but unrelated to hip BMD. Equivalent positive associations were not seen for low or medium impacts. CONCLUSIONS Despite their rarity, habitual levels of higher impacts were positively associated with lower limb bone size and strength, whereas equivalent relationships were not seen for low or medium impacts.
Collapse
Affiliation(s)
- K Hannam
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Southmead Hospital, Bristol, BS10 5NB, UK
| | - K C Deere
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Southmead Hospital, Bristol, BS10 5NB, UK
| | - A Hartley
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Southmead Hospital, Bristol, BS10 5NB, UK
| | - U A Al-Sari
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Southmead Hospital, Bristol, BS10 5NB, UK
| | - E M Clark
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Southmead Hospital, Bristol, BS10 5NB, UK
| | | | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Southmead Hospital, Bristol, BS10 5NB, UK.
| |
Collapse
|
5
|
Hannam K, Deere KC, Hartley A, Clark EM, Coulson J, Ireland A, Moss C, Edwards MH, Dennison E, Gaysin T, Cooper R, Wong A, McPhee JS, Cooper C, Kuh D, Tobias JH. A novel accelerometer-based method to describe day-to-day exposure to potentially osteogenic vertical impacts in older adults: findings from a multi-cohort study. Osteoporos Int 2017; 28:1001-1011. [PMID: 27798733 PMCID: PMC5306163 DOI: 10.1007/s00198-016-3810-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/12/2016] [Indexed: 10/26/2022]
Abstract
UNLABELLED This observational study assessed vertical impacts experienced in older adults as part of their day-to-day physical activity using accelerometry and questionnaire data. Population-based older adults experienced very limited high-impact activity. The accelerometry method utilised appeared to be valid based on comparisons between different cohorts and with self-reported activity. INTRODUCTION We aimed to validate a novel method for evaluating day-to-day higher impact weight-bearing physical activity (PA) in older adults, thought to be important in protecting against osteoporosis, by comparing results between four cohorts varying in age and activity levels, and with self-reported PA levels. METHODS Participants were from three population-based cohorts, MRC National Survey of Health and Development (NSHD), Hertfordshire Cohort Study (HCS) and Cohort for Skeletal Health in Bristol and Avon (COSHIBA), and the Master Athlete Cohort (MAC). Y-axis peaks (reflecting the vertical when an individual is upright) from a triaxial accelerometer (sampling frequency 50 Hz, range 0-16 g) worn at the waist for 7 days were classified as low (0.5-1.0 g), medium (1.0-1.5 g) or higher (≥1.5 g) impacts. RESULTS There were a median of 90, 41 and 39 higher impacts/week in NSHD (age 69.5), COSHIBA (age 76.8) and HCS (age 78.5) participants, respectively (total n = 1512). In contrast, MAC participants (age 68.5) had a median of 14,322 higher impacts/week. In the three population cohorts combined, based on comparison of beta coefficients, moderate-high-impact activities as assessed by PA questionnaire were suggestive of stronger association with higher impacts from accelerometers (0.25 [0.17, 0.34]), compared with medium (0.18 [0.09, 0.27]) and low impacts (0.13 [0.07,0.19]) (beta coefficient, with 95 % CI). Likewise in MAC, reported moderate-high-impact activities showed a stronger association with higher impacts (0.26 [0.14, 0.37]), compared with medium (0.14 [0.05, 0.22]) and low impacts (0.03 [-0.02, 0.08]). CONCLUSIONS Our new accelerometer method appears to provide valid measures of higher vertical impacts in older adults. Results obtained from the three population-based cohorts indicate that older adults generally experience very limited higher impact weight-bearing PA.
Collapse
Affiliation(s)
- K Hannam
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Bristol, BS10 5NB, UK
| | - K C Deere
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Bristol, BS10 5NB, UK
| | - A Hartley
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Bristol, BS10 5NB, UK
| | - E M Clark
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Bristol, BS10 5NB, UK
| | - J Coulson
- School of Healthcare Sciences, Manchester Metropolitan University, Manchester, M15 6BH, UK
| | - A Ireland
- School of Healthcare Sciences, Manchester Metropolitan University, Manchester, M15 6BH, UK
| | - C Moss
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - T Gaysin
- MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 6BT, UK
| | - R Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 6BT, UK
| | - A Wong
- MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 6BT, UK
| | - J S McPhee
- School of Healthcare Sciences, Manchester Metropolitan University, Manchester, M15 6BH, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - D Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, WC1E 6BT, UK
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Bristol, BS10 5NB, UK.
| |
Collapse
|