Frailty Questionnaire Is Not a Strong Prognostic Factor for Functional Outcomes in Hip or Knee Arthroplasty Patients

Abstract

Introduction:Up to 33% and 25% of patients with end-stage hip and knee osteoarthritis (OA) are considered frail by the Groningen Frailty Indicator (GFI). This study aims to assess whether frail patients have lower functional gains after arthroplasty and to assess GFI as a tool to discriminate between good and adverse change score.Materials and Methods:Patients with end-stage hip/knee OA scheduled for arthroplasty were recruited from the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis Study. Functional outcome was measured as change score on the Hip Osteoarthritis Outcome Score/Knee Osteoarthritis Outcome Score (HOOS/KOOS), by subtracting preoperative score from 1-year postsurgery score and then dichotomized based on a cutoff of 20 points. For each HOOS/KOOS subscale, 3 models were estimated: GFI univariate (model 1), GFI and baseline score (model 2), and baseline score univariate (model 3). A receiver operating characteristic analysis was performed to assess the discriminative ability of each model.Results:Eight hundred five patients with end-stage hip OA (31.4% frail) and 640 patients with end-stage knee OA (25.4% frail) were included. Frail patients were older, had a higher body mass index, had more comorbidities, and lived more often alone. Persons considered frail by GFI had significant lower baseline score; however, except for “function in sports and recreation” and “quality of life,” change scores were similar in frail and nonfrail persons. The discriminatory value of GFI was negligible for all HOOS/KOOS subscales. Baseline score, however, was adequate to discriminate between total knee arthroplasty patients with more or less than twice the minimally clinically important difference on KOOS symptoms subscale (area under the curve = 0.802).Discussion/Conclusion:Although frail patients with OA have lower functioning scores at baseline, the change scores on HOOS/KOOS subscales are similar for both frail and nonfrail patients. Exploring other heath assessements may improve patient-specific outcome prediction.

Prevalence and Characteristics of Frailty at 6 months Following Total Hip and Knee Arthroplasty in Patients With End-Stage OA

“… 40 , 41 However, an earlier study demonstrated that the improvement in functional scores was similar for both frail and non-frail patients despite the older median age in the frailty group. The current study found that residual frailty following THA and TKA was significantly associated with older age, 7 but the associations remain controversial. Further studies are needed to assess the effect of age on improving frailty as a prognostic factor in OA patients following THA and TKA.…”

“…In previous research, frail patients with OA had more adverse events in daily activities after THA and TKA; consequently, they had an increased dependence on outside help, and a decrease in IADL and HRQoL. 32 , 33 Reportedlly, total joint arthroplasty for hip and knee OA is highly effective in relieving pain and improving physical function, 7 , 34 , 35 which is supported by our findings showing significant improvement in pain, IADL, and HRQoL at 6 months after surgery. We also found that frailty in patients was significantly decreased from 57.4 to 38.2% by THA and TKA procedures.…”

“… 6 Thus far, no cure for OA has been found; instead when pain relief is no longer sufficient, the final treatment option is total joint arthroplasty of the hip (total hip arthroplasty [THA]) or knee (total knee arthroplasty [TKA]). 7 Surgery and its postoperative rehabilitation are causally linked to the improvement of pain and the recovery of physical function. On the other hand, OA is associated with increased mortality, increased length of stay in hospital, higher chance of readmission, and higher rates of discharge to institutional care after THA and TKA in frail patients than in non-frail patients with OA.…”

Modified frailty index as a predictor of the long-term functional result in patients undergoing primary total hip arthroplasty

“…The relationships of gender, alcohol consumption, socioeconomic status, allergy, and vitamin D insufficiency and functional outcome after THA are unclear [22]. Meessen et al [23] studied the impact of frailty (Groningen Frailty Indicator, GFI) on the functional outcomes after THA and total knee arthroplasty (TKA). In the regression analysis, the GFI had limited ability to affect the functional outcome change (HOOS) in THA patients.…”

“…Meessen et al [ 23 ] studied the impact of frailty (Groningen Frailty Indicator, GFI) on the functional outcomes after THA and total knee arthroplasty (TKA). In the regression analysis, the GFI had limited ability to affect the functional outcome change (HOOS) in THA patients.…”