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Willems I, Verbestel V, Dumuid D, Stanford TE, Calders P, Lapauw B, Bogaert L, Blom MT, den Braver NR, van der Velde JHPM, Rutters F, De Craemer M. Cross-sectional associations between 24-hour movement behaviors and cardiometabolic health among adults with type 2 diabetes mellitus: A comparison according to weight status. J Sci Med Sport 2024; 27:179-186. [PMID: 38114412 DOI: 10.1016/j.jsams.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) is a chronic disease associated with overweight and obesity. Evidence suggests that 24-hour movement behaviors (24 h-MBs) play a crucial role in cardiometabolic health. However, it is not yet known if 24 h-MBs differ between weight status groups among people with T2DM (PwT2DM) and how 24 h-MBs are associated with their cardiometabolic health. DESIGN Cross-sectional study. METHODS Cardiometabolic variables (i.e. Body Mass Index (BMI), waist circumference (WC), HbA1c, fasting glucose, triglycerides, total-cholesterol, HDL-cholesterol, LDL-cholesterol, blood pressure) and 24 h-MBs (accelerometry and sleep-diary) of 1001 PwT2DM were collected. Regression models using compositional data analysis explored differences in 24 h-MBs between weight status groups and analyzed associations with cardiometabolic variables. RESULTS The 24 h-MBs of PwT2DM being obese consisted of less sleep, light physical activity (LPA) and moderate to vigorous physical activity (MVPA) and more sedentary time (ST) per day as compared to PwT2DM being overweight or normal weight (p < 0.001). Regardless of weight status, the largest associations were found when reallocating 20 min a day from ST into MVPA for BMI (-0.32 kg/m2; [-0.55; -0.09], -1.09 %), WC (-1.44 cm, [-2.26; -0.62], -1.35 %) and HDL-cholesterol (0.02 mmol/l, [0.01, 0.02], +1.59 %), as well as from ST into LPA for triglycerides (-0.04 mmol/l, [-0.05; -0.03], -2.3 %). Moreover, these associations were different when stratifying people by short-to-average (7.7 h/night) versus long sleep (9.3 h/night) period. CONCLUSIONS This study highlights the importance of 24 h-MBs in the cardiometabolic health of PwT2DM. Shifting time from ST and/or sleep toward LPA or MVPA might theoretically benefit cardiometabolic health among relatively inactive PwT2DM, irrespective of weight status.
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Affiliation(s)
- Iris Willems
- Ghent University, Department of Rehabilitation Sciences, Belgium; Research Foundation Flanders, Belgium.
| | - Vera Verbestel
- Maastricht University, Department of Health Promotion, Research Institute of Nutrition and Translational Research in Metabolism & Care and Public Health Institute, the Netherlands.
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health & Human Performance, University of South Australia, Australia.
| | - Tyman E Stanford
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health & Human Performance, University of South Australia, Australia.
| | - Patrick Calders
- Ghent University, Department of Rehabilitation Sciences, Belgium.
| | - Bruno Lapauw
- Department of Internal Medicine and Pediatrics & Department of Endocrinology, Ghent University Hospital & Ghent University, Belgium.
| | - Lotte Bogaert
- Ghent University, Department of Rehabilitation Sciences, Belgium.
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit, the Netherlands.
| | - Nicolette R den Braver
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, the Netherlands.
| | | | - Femke Rutters
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, the Netherlands.
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Dumuid D, Stanford TE, Pedišić Ž, Maher C, Lewis LK, Martín-Fernández JA, Katzmarzyk PT, Chaput JP, Fogelholm M, Standage M, Tremblay MS, Olds T. Adiposity and the isotemporal substitution of physical activity, sedentary time and sleep among school-aged children: a compositional data analysis approach. BMC Public Health 2018; 18:311. [PMID: 29499689 PMCID: PMC5834855 DOI: 10.1186/s12889-018-5207-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/22/2018] [Indexed: 11/28/2022] Open
Abstract
Background Daily activity data are by nature compositional data. Accordingly, they occupy a specific geometry with unique properties that is different to standard Euclidean geometry. This study aimed to estimate the difference in adiposity associated with isotemporal reallocation between daily activity behaviours, and to compare the findings from compositional isotemporal subsitution to those obtained from traditional isotemporal substitution. Methods We estimated the differences in adiposity (body fat%) associated with reallocating fixed durations of time (isotemporal substitution) between accelerometer-measured daily activity behaviours (sleep, sedentary time and light and moderate-to-vigorous physical activity (MVPA)) among 1728 children aged 9–11 years from Australia, Canada, Finland and the UK (International Study of Childhood Obesity, Lifestyle and the Environment, 2011–2013). We generated estimates from compositional isotemporal substitution models and traditional non-compositional isotemporal substitution models. Results Both compositional and traditional models estimated a positive (unfavourable) difference in body fat% when time was reallocated from MVPA to any other behaviour. Unlike traditional models, compositional models found the differences in estimated adiposity (1) were not necessarily symmetrical when an activity was being displaced, or displacing another (2) were not linearly related to the durations of time reallocated, and (3) varied depending on the starting composition. Conclusion The compositional isotemporal model caters for the constrained and therefore relative nature of activity behaviour data and enables all daily behaviours to be included in a single statistical model. The traditional model treats data as real variables, thus the constrained nature of time is not accounted for, nor reflected in the findings. Findings from compositional isotemporal substitution support the importance of MVPA to children’s health, and suggest that while interventions to increase MVPA may be of benefit, attention should be directed towards strategies to avoid decline in MVPA levels, particularly among already inactive children. Future applications of the compositional model can extend from pair-wise reallocations to other configurations of time-reallocation, for example, increasing MVPA at the expense of multiple other behaviours. Electronic supplementary material The online version of this article (10.1186/s12889-018-5207-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Tyman E Stanford
- School of Mathematical Sciences, The University of Adelaide, Adelaide, Australia.,LBT Innovations, Adelaide, Australia
| | - Željko Pedišić
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Lucy K Lewis
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.,School of Health Sciences, Flinders University and School of Health Sciences, University of South Australia, Adelaide, Australia
| | | | | | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | | | - Mark S Tremblay
- Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Timothy Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
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Dumuid D, Maher C, Lewis LK, Stanford TE, Martín Fernández JA, Ratcliffe J, Katzmarzyk PT, Barreira TV, Chaput JP, Fogelholm M, Hu G, Maia J, Sarmiento OL, Standage M, Tremblay MS, Tudor-Locke C, Olds T. Human development index, children's health-related quality of life and movement behaviors: a compositional data analysis. Qual Life Res 2018; 27:1473-1482. [PMID: 29362939 DOI: 10.1007/s11136-018-1791-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Health-related quality of life has been related to physical activity, sedentary behavior, and sleep among children from developed nations. These relationships have rarely been assessed in developing nations, nor have behaviors been considered in their true context, as mutually exclusive and exhaustive parts of the movement behavior composition. This study aimed to explore whether children's health-related quality of life is related to their movement behavior composition and if the relationship differs according to human development index. METHODS Children aged 9-11 years (n = 5855), from the 12-nation cross-sectional observational International Study of Childhood Obesity, Lifestyle and the Environment 2011-2013, self-reported their health-related quality of life (KIDSCREEN-10). Daily movement behaviors were from 24-h, 7-day accelerometry. Isometric log-ratio mixed-effect linear models were used to calculate estimates for difference in health-related quality of life for the reallocation of time between daily movement behaviors. RESULTS Children from countries of higher human development index reported stronger positive relationships between health-related quality of life and moderate-to-vigorous physical activity, relative to the remaining behaviors (r = 0.75, p = 0.005) than those from lower human development index countries. In the very high human development index strata alone, health-related quality of life was significantly related to the movement behavior composition (p = 0.005), with moderate-to-vigorous physical activity (relative to remaining behaviors) being positively associated with health-related quality of life. CONCLUSIONS The relationship between children's health-related quality of life and their movement behaviors is moderated by their country's human development index. This should be considered when 24-h movement behavior guidelines are developed for children around the world.
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Affiliation(s)
- Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, Australia.
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Lucy K Lewis
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, Australia.,School of Health Sciences, Flinders University, Adelaide, Australia
| | - Tyman E Stanford
- LBT Innovations, Adelaide, Australia.,School of Mathematical Sciences, The University of Adelaide, Adelaide, Australia
| | | | - Julie Ratcliffe
- Institute for Choice, University of South Australia, Adelaide, Australia
| | | | - Tiago V Barreira
- Pennington Biomedical Research Center, Baton Rouge, USA.,School of Education, Syracuse University, New York, USA
| | | | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, USA
| | - José Maia
- Faculty of Sport, University of Porto, Porto, Portugal
| | | | | | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Catrine Tudor-Locke
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, USA
| | - Timothy Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, Australia
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Dumuid D, Stanford TE, Martin-Fernández JA, Pedišić Ž, Maher CA, Lewis LK, Hron K, Katzmarzyk PT, Chaput JP, Fogelholm M, Hu G, Lambert EV, Maia J, Sarmiento OL, Standage M, Barreira TV, Broyles ST, Tudor-Locke C, Tremblay MS, Olds T. Compositional data analysis for physical activity, sedentary time and sleep research. Stat Methods Med Res 2017; 27:3726-3738. [PMID: 28555522 DOI: 10.1177/0962280217710835] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The health effects of daily activity behaviours (physical activity, sedentary time and sleep) are widely studied. While previous research has largely examined activity behaviours in isolation, recent studies have adjusted for multiple behaviours. However, the inclusion of all activity behaviours in traditional multivariate analyses has not been possible due to the perfect multicollinearity of 24-h time budget data. The ensuing lack of adjustment for known effects on the outcome undermines the validity of study findings. We describe a statistical approach that enables the inclusion of all daily activity behaviours, based on the principles of compositional data analysis. Using data from the International Study of Childhood Obesity, Lifestyle and the Environment, we demonstrate the application of compositional multiple linear regression to estimate adiposity from children's daily activity behaviours expressed as isometric log-ratio coordinates. We present a novel method for predicting change in a continuous outcome based on relative changes within a composition, and for calculating associated confidence intervals to allow for statistical inference. The compositional data analysis presented overcomes the lack of adjustment that has plagued traditional statistical methods in the field, and provides robust and reliable insights into the health effects of daily activity behaviours.
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Affiliation(s)
- Dorothea Dumuid
- 1 School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Tyman E Stanford
- 2 School of Mathematical Sciences, University of Adelaide, Adelaide, Australia
| | | | - Željko Pedišić
- 4 Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Carol A Maher
- 1 School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Lucy K Lewis
- 6 Department of Mathematical Analysis and Applications of Mathematics, Univerzita Palackeho, Olomouc, Czech Republic
| | - Karel Hron
- 6 Department of Mathematical Analysis and Applications of Mathematics, Univerzita Palackeho, Olomouc, Czech Republic
| | | | - Jean-Philippe Chaput
- 8 Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Mikael Fogelholm
- 9 Department of Food and Environmental Sciences, Helsingin Yliopisto, Helsinki, Finland
| | - Gang Hu
- 7 Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Estelle V Lambert
- 10 Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - José Maia
- 11 Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - Olga L Sarmiento
- 12 Faculty of Medicine, Universidad de los Andes, Bogota, Colombia
| | | | - Tiago V Barreira
- 14 Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | | | | | - Mark S Tremblay
- 8 Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Timothy Olds
- 1 School of Health Sciences, University of South Australia, Adelaide, Australia
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Stanford TE, Bagley CJ, Solomon PJ. Informed baseline subtraction of proteomic mass spectrometry data aided by a novel sliding window algorithm. Proteome Sci 2016; 14:19. [PMID: 27980460 PMCID: PMC5142289 DOI: 10.1186/s12953-016-0107-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Proteomic matrix-assisted laser desorption/ionisation (MALDI) linear time-of-flight (TOF) mass spectrometry (MS) may be used to produce protein profiles from biological samples with the aim of discovering biomarkers for disease. However, the raw protein profiles suffer from several sources of bias or systematic variation which need to be removed via pre-processing before meaningful downstream analysis of the data can be undertaken. Baseline subtraction, an early pre-processing step that removes the non-peptide signal from the spectra, is complicated by the following: (i) each spectrum has, on average, wider peaks for peptides with higher mass-to-charge ratios (m/z), and (ii) the time-consuming and error-prone trial-and-error process for optimising the baseline subtraction input arguments. With reference to the aforementioned complications, we present an automated pipeline that includes (i) a novel ‘continuous’ line segment algorithm that efficiently operates over data with a transformed m/z-axis to remove the relationship between peptide mass and peak width, and (ii) an input-free algorithm to estimate peak widths on the transformed m/z scale. Results The automated baseline subtraction method was deployed on six publicly available proteomic MS datasets using six different m/z-axis transformations. Optimality of the automated baseline subtraction pipeline was assessed quantitatively using the mean absolute scaled error (MASE) when compared to a gold-standard baseline subtracted signal. Several of the transformations investigated were able to reduce, if not entirely remove, the peak width and peak location relationship resulting in near-optimal baseline subtraction using the automated pipeline. The proposed novel ‘continuous’ line segment algorithm is shown to far outperform naive sliding window algorithms with regard to the computational time required. The improvement in computational time was at least four-fold on real MALDI TOF-MS data and at least an order of magnitude on many simulated datasets. Conclusions The advantages of the proposed pipeline include informed and data specific input arguments for baseline subtraction methods, the avoidance of time-intensive and subjective piecewise baseline subtraction, and the ability to automate baseline subtraction completely. Moreover, individual steps can be adopted as stand-alone routines. Electronic supplementary material The online version of this article (doi:10.1186/s12953-016-0107-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tyman E Stanford
- School of Mathematical Sciences, The University of Adelaide, North Terrace, Adelaide, 5005 Australia
| | - Christopher J Bagley
- School of Mathematical Sciences, The University of Adelaide, North Terrace, Adelaide, 5005 Australia
| | - Patty J Solomon
- School of Mathematical Sciences, The University of Adelaide, North Terrace, Adelaide, 5005 Australia
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Miller J, Makrides M, Gibson RA, McPhee AJ, Stanford TE, Morris S, Ryan P, Collins CT. Effect of increasing protein content of human milk fortifier on growth in preterm infants born at <31 wk gestation: a randomized controlled trial. Am J Clin Nutr 2012; 95:648-55. [PMID: 22301933 DOI: 10.3945/ajcn.111.026351] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preterm human milk-fed infants often experience suboptimal growth despite the use of human milk fortifier (HMF). The extra protein supplied in fortifiers may be inadequate to meet dietary protein requirements for preterm infants. OBJECTIVE We assessed the effect of human milk fortified with a higher-protein HMF on growth in preterm infants. DESIGN This is a randomized controlled trial in 92 preterm infants born at <31 wk gestation who received maternal breast milk that was fortified with HMF containing 1.4 g protein/100 mL (higher-protein group) or 1.0 g protein/100 mL (current practice) until discharge or estimated due date, whichever came first. The HMFs used were isocaloric and differed only in the amount of protein or carbohydrate. Length, weight, and head-circumference gains were assessed over the study duration. RESULTS Length gains did not differ between the higher- and standard-protein groups (mean difference: 0.06 cm/wk; 95% CI: -0.01, 0.12 cm/wk; P = 0.08). Infants in the higher-protein group achieved a greater weight at study end (mean difference: 220 g; 95% CI: 23, 419 g; P = 0.03). Secondary analyses showed a significant reduction in the proportion of infants who were less than the 10th percentile for length at the study end in the higher-protein group (risk difference: 0.186; 95% CI: 0.370, 0.003; P = 0.047). CONCLUSIONS A higher protein intake results in less growth faltering in human milk-fed preterm infants. It is possible that a higher-protein fortifier than used in this study is needed. This trial was registered with the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/) as ACTRN12606000525583.
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Affiliation(s)
- Jacqueline Miller
- Child Nutrition Research Centre, Women's and Children's Health Research Institute, Flinders Medical Centre, Bedford Park,Australia
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Abstract
BACKGROUND AND PURPOSE Despite concerns regarding a higher risk of revision, unicompartmental knee arthroplasty (UKA) continues to be used as an alternative to total knee arthroplasty (TKA). There are, however, limited data on the subsequent outcome when a UKA is revised. We examined the survivorship for primary UKA procedures that have been revised. METHODS We used data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to analyze the survivorship of 1,948 revisions of primary UKA reported to the Registry between September 1999 and December 2008. This was compared to the results of revisions of primary TKA reported during the same period where both the femoral and tibial components were revised. The Kaplan-Meier method for modeling survivorship was used. RESULTS When a primary UKA was revised to another UKA (both major and minor revisions), it had a cumulative per cent revision (CPR) of 28 and 30 at 3 years, respectively. The CPR at 3 years when a UKA was converted to a TKA was 10. This is similar to the 3-year CPR (12) found earlier for primary TKA where both the femoral and tibial components were revised. INTERPRETATION When a UKA requires revision, the best outcome is achieved when it is converted to a TKA. This procedure does, however, have a major risk of re-revision, which is similar to the risk of re-revision of a primary TKA that has had both the femoral and tibial components revised.
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Affiliation(s)
| | - Tyman E Stanford
- Data Management and Analysis Centre, University of Adelaide, SAAustralia
| | | | | | | | - Lisa N Miller
- Data Management and Analysis Centre, University of Adelaide, SAAustralia
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Abstract
BACKGROUND AND PURPOSE Recent years have seen a rapid increase in the use of resurfacing hip arthroplasty despite the lack of literature on the long-term outcome. In particular, there is little evidence regarding the outcome of revisions of primary resurfacing. The purpose of this analysis was to examine the survivorship of primary resurfacing hip arthroplasties that have been revised. PATIENTS AND METHODS Over 12,000 primary resurfacing hip arthroplasties were recorded by the Australian Orthopaedic Association National Joint Replacement Registry between September 1, 1999 and December 31, 2008. During this time, 397 revisions for reasons other than infection were reported for these primary resurfacings and classified as acetabular, femoral, or both acetabular and femoral revisions. The survivorship of the different types of revisions was estimated using the Kaplan-Meier method and compared using proportional hazard models. Additionally, the outcome of a femoral-only revision was compared to that of primary conventional total hip arthroplasty. RESULTS Acetabular-only revision had a high risk of re-revision compared to femoral-only and both acetabular and femoral revision (5-year cumulative per cent revision of 20%, 7%, and 5% respectively). Femoral-only revision had a risk of re-revision similar to that of revision of both the acetabular and femoral components. Femoral-only revision had over twice the risk of revision of primary conventional total hip arthroplasty. INTERPRETATION Revision of a primary resurfacing arthroplasty is associated with a major risk of re-revision. The best outcome is achieved when either the femoral-only or both the acetabular and femoral components are revised. Technically straightforward femoral-only revisions generally have a worse outcome than a primary conventional total hip arthroplasty.
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Affiliation(s)
| | - Lisa N Miller
- Data Management and Analysis Centre, University of Adelaide
| | - Gareth H Prosser
- Perth Orthopaedic Institute, Fremantle Hospital and University of Western Australia, FreemantleAustralia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry
| | - David C Davidson
- Australian Orthopaedic Association National Joint Replacement Registry
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