Conceptualizing Biological Aging and Frailty in Orthopaedics: A Framework for Clinical Practice

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.