4 Journal of Aging Research Table 2: Health and functional characteristics of participants with and without a total joint replacement in the past. Total joint replacement Yes (N = 38) No (N = 561) P value Crude Gender adjusted 15.9 (12.0–18.8) 13.6 (10.8–17.8) Adjustment for gender after log transformation of nonparametric variables. £N = 526, N with prosthesis = 34. §N = 450, N with prosthesis = 28. SD: standard deviation. IQR: interquartile range. GARS: Groningen Activity Restriction Scale. (I) ADL: (Instrumental) activities of daily living. Physical functioning Able to walk (number, %) Gait speed (m/s, mean, SD)£ 5x stand up test (sec, median, IQR)§ Grip strength (kg, mean, SD) Physical activity score (points, median, IQR) GARS ADL (points, median, IQR) IADL (points, median, IQR) Joint complaints Pain hip (number, %) Pain knee (number, %) Stiﬀness hip (number, %) Stiﬀness knee (number, %) Self reported status Cantril ladder (point, mean, SD) Self reported health “good” (number, %) 34 (90) 0.42 (0.18) 21.4 (9.0) 3 (1–6) 10.5 (9–14) 18.5 (13–25) 15 (40) 16 (42) 8 (21) 11 (29) 7.8 (1.5) 26 (88) were compared. No diﬀerences in the prevalence of chronic, age-related diseases were found between the two groups except for the prevalence of arthritis. No diﬀerences in physical functioning were found except for a lower gait speed in the group with a total joint replacement. This group also complained more about joint pain. Furthermore, an attenuated mortality rate during followup was observed in this group. Gait speed is considered to be an important predictor of functional status and adverse health events [18, 19]. It is also related to functional activities, such as crossing the street [19]. A recently published study conﬁrmed our results of lower gait speed in subjects with a total joint replacement [19]. That study showed slower gait speed in middle aged to elderly patients who received a total hip replacement about 2.5 years before [19]. More severe joint pain is associated with lower gait speed in patients with osteoarthritis (OA) [20]. The group with total joint replacement complained more of joint pain; this could have contributed to the lower gait speed. It was not recorded whether the joint pain complaints came from the left, right, or both sides. A reason why oldest old participants with a joint replacement complained more about joint pain can be the presence of OA in the other lower extremity joints. Since total joint replacement is the end-stage treatment of OA, other joints are likely to be aﬀected by OA as well [21, 22]. With our data, we could not perform a cost-eﬀectiveness analysis for total joint replacement in the oldest old. Literature on cost-eﬀectiveness in the general OA population 492 (88) 0.53 (0.22) 22.7 (8.9) 3 (0–4) 10 (9–15) 18 (12–27) 91 (16) 123 (22) 70 (13) 94 (17) 7.5 (1.8) 392 (70) 1 0.8 l 0.6 a v i v r u S 0.4 0.2 0 86 Yes No 0.75 0.003 0.31 0.41 0.12 0.68 0.93 0.004 0.05 0.63 0.50 0.35 0.71 0.69 0.006 0.31 0.69 0.11 0.74 0.98 0.007 0.06 0.59 0.55 0.35 0.70 92 Age (years) 88 90 94 96 98 Total joint replacement Figure 1: Mortality of participants with and without a total joint replacement in the past. shows that both total hip and knee replacement are (highly) cost-eﬀective [23, 24]. A smaller study shows cost-eﬀective