Conceptualizing Biological Aging and Frailty in Orthopaedics

A Framework for Clinical Practice

Abstract

• ➤ Biological aging can best be conceptualized clinically as a combination of 3 components: frailty, comorbidity, and disability.
• ➤ Despite advancements in the understanding of senescence, chronological age remains the best estimate of biological age. However, a useful exercise for practitioners is to look beyond chronological age in clinical and surgical decision-making.
• ➤ A chronologically aging person does not age biologically at the same rate.
• ➤ The best way to understand frailty is to consider it as a physical phenotype.
• ➤ Physical optimization should parallel medical optimization before elective surgery.
• ➤ The poorer the host (both in terms of bone quality and propensity for healing), the more robust the implant construct must be to minimize reliance on host biology.