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

Abstract

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.

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

“…Although total hip arthroplasty is one of the most common orthopedic procedures in older adults, studies of the frailty and THA results are limited to the traditional outcomes [7]. In this study, we analyzed the complex impact of frailty on the outcomes of THA focusing on patient-centered outcome measures such as long-term function (WOMAC, HHS), pain sensations (VAS), and satisfaction (HKAAS).…”

“…Schmucker et al [7] performed a systematic review of the impact of frailty on outcomes after THA and TKA.…”

“…They require prolonged hospitalization and achieve worse functional outcomes [6]. The identification of patients with frailty syndrome subjected to THA could lead to more accurate qualification for the procedure and provide high-risk patients with special perioperative care [7].…”

“…In the study by Shin et al [11], carried out on 14 583 patients undergoing THA, mFI-11 showed better predictive properties than ASA score in complications and 30-day mortality. However, the previous research conducted on mFI-5 and mFI-11 has not included the aspect of the long-term physical functioning of patients, pain severity, and satisfaction rate after the THA [7].…”

The maximal gait speed is a simple and useful prognostic indicator for functional recovery after total hip arthroplasty

“…Previous studies have reported that functional indicators such as TUG and sit-to-stand test are useful in predicting postoperative recovery [7-10, 14, 19-22]. In addition, with the increasing age of patients who undergo artificial joint replacement, the importance of evaluating physical frailty has been reported in recent years [23]. Currently, various methods are used to assess physical frailty, but due to its simplicity and predictive capability, gait speed has become a core strategy to evaluate physical frailty.…”