Is frailty associated with adverse events after total joint arthroplasty?

Mandl, Lisa A.; Schmucker, Abigail M.; Hupert, Nathaniel; Sasaki, Mayu; Do, Junghwa; Cross, Michael B.; Valle, Alejandro González Della; Figgie, Mark P.; Jerabek, Seth A.; Szymonifka, Jackie; Magid, Steven K.

doi:10.1016/j.joca.2018.02.484

Cited by 2 publications

(3 citation statements)

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“…One of 11 cohort studies did not find a significant association between a frailty measure and postoperative AEs or clinical outcomes. Mandl et al 44 used a composite frailty scale derived from select items from the Fried 45 and Robinson 46 frailty scales. They did not find significant associations between frailty and short-term AEs; they did not quantify these relationships beyond the lack of statistical significance.…”

Section: Resultsmentioning

confidence: 99%

“…Preliminary data from Hospital for Special Surgery indicate that at least 8% of TKA patients are frail. 44 Given current projections, this would correspond with >278 000 frail TKA cases annually in the United States by 2030. 2 These absolute numbers are likely to increase dramatically as TKA volume is projected to increase even more than THA volume over the coming decades.…”

Section: Discussionmentioning

confidence: 99%

“…Only 1 of 11 reviewed studies failed to report an association between frailty and poor short-term outcomes after TJA; this was an interim analysis of an ongoing study and so may have been underpowered. 44 These findings are particularly relevant for older adults choosing elective surgery to improve quality of life. Elective procedures are only performed on patients who are deemed medically well enough to be surgical candidates.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Frailty on Short-Term Outcomes After Elective Hip and Knee Arthroplasty in Older Adults: A Systematic Review

Schmucker

Hupert

Mandl

2019

Geriatr Orthop Surg Rehabil

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Introduction: This systematic literature review evaluates (1) frailty in older adults as a risk factor for short-term adverse events and suboptimal clinical outcomes after total joint arthroplasty and (2) interventions to improve arthroplasty outcomes in these frail patients. Methods: PubMed, EMBASE, Cochrane Register of Controlled Trials, SCOPUS, AgeLine, and Web of Science were searched from database inception to November 22, 2017; gray literature and references were also searched. Studies including adults ≥65 years of age undergoing hip or knee arthroplasty and measuring preoperative frailty and postoperative adverse events or clinical outcomes within 90 days of surgery were included. Two investigators independently screened all abstracts and extracted data; disagreements were adjudicated by a third reviewer. Risk of bias was assessed using the Newcastle–Ottawa scale for cohort studies and the Cochrane Risk of Bias tool for randomized controlled trials. Study quality was assessed using a 5-point scale modified from the Oxford Centre for Evidence-Based Medicine tool. Results: Of 1913 abstracts identified, 82 full texts were reviewed, and 13 met inclusion criteria: 5 prospective cohort studies, 6 retrospective cohort studies, and 2 randomized controlled trials covering 382 763 total patients. These studies used 13 frailty instruments and assessed 32 distinct outcomes. Substantial heterogeneity precluded valid meta-analysis; results were qualitatively summarized by study design, frailty instrument, and outcome type. Of the 11 cohort studies, 10 found significant associations between frailty and poor postoperative outcomes. Trials of preoperative frailty-modifying interventions found no association between interventions and improved outcomes. Discussion: Standardizing frailty measurement would improve generalizability, permitting the assessment of associations with patient-reported and functional outcome measures, as well as the efficacy of interventions to improve outcomes, in frail patients undergoing arthroplasty. Conclusions: Frailty is associated with higher rates of short-term adverse events and worse clinical outcomes after elective hip and knee arthroplasty.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Impact of Frailty on Short-Term Outcomes After Elective Hip and Knee Arthroplasty in Older Adults: A Systematic Review

Schmucker

Hupert

Mandl

2019

Geriatr Orthop Surg Rehabil

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Frailty in end-stage hip or knee osteoarthritis: validation of the Groningen Frailty Indicator (GFI) questionnaire

et al. 2017

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Frailty is highly prevalent in the elderly, increasing the risk of poor health outcomes. The Groningen Frailty Indicator (GFI) is a 15-item validated questionnaire for the elderly. Its value in patients with end-stage hip or knee osteoarthritis (OA) has not yet been determined. This study assesses the validity of the GFI in this patient group. End-stage hip or knee OA patients completed the GFI (range 0–15, ≥ 4 = frail) before arthroplasty surgery. Convergent validity was determined by Spearman-rank correlation between the SF-12 physical (PCS) and mental (MCS) component scores and the physical and mental GFI-domains, respectively. Discriminant validity was assessed by means of overall GFI-score and the pain-domain of the Hip/Knee Osteoarthritis Outcome Score (HOOS/KOOS). Altogether 3275 patients were included of whom 2957 (90.3%) completed the GFI. Mean GFI-scores were 2.78 (2.41) and 2.28 (1.99) in hip and knee OA-patients, respectively, with 570 (35.9%) of hip and 344 (24.1%) of knee patients considered frail. The convergent validity was moderate to strong (physical domain R = − 0.4, mental domain R = − 0.6) and discriminant validity low (R HOOS/KOOS-pain domain = − 0.2), confirming the validity of the GFI-questionnaire in this population. With 90% of participants completing the GFI, it is a feasible and valid questionnaire to assess frailty in end-stage hip and knee OA-patients. One-third (33.3%) of the patients undergoing hip arthroplasty and a quarter (24.1%) of those undergoing knee arthroplasty are frail. Whether this is associated with worse outcomes and can thus be used as a pre-operative predictor needs to be explored.

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Is frailty associated with adverse events after total joint arthroplasty?

Cited by 2 publications

References 0 publications

The Impact of Frailty on Short-Term Outcomes After Elective Hip and Knee Arthroplasty in Older Adults: A Systematic Review

The Impact of Frailty on Short-Term Outcomes After Elective Hip and Knee Arthroplasty in Older Adults: A Systematic Review

Frailty in end-stage hip or knee osteoarthritis: validation of the Groningen Frailty Indicator (GFI) questionnaire

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