Current state of frailty in revision arthroplasty
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Introduction: The use of frailty indices in orthopedics has grown in popularity to predict surgical outcomes in at-risk populations. While multiple instruments have been used to assess frailty in revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA), there are no comprehensive analyses of the variable indices in this context. The purpose of this study is to thoroughly examine the current landscape of frailty scales used to predict outcomes for rTHA and rTKA. Methods: A comprehensive database search was conducted in accordance with PRISMA guidelines, using the terms: (frailty) AND ("revision" AND ("arthroplasty" OR "knee" OR "hip" OR "joint")). Two blinded reviewers assessed eligibility of studies, conducted a critical appraisal using the Cochrane Risk of Bias, and performed data extraction utilizing a predefined form. Results: There were seven studies which met final inclusion criteria, consisting of 159,594 patients. Included articles utilized national databases (5) and retrospective chart reviews (2). The frailty indices utilized to analyze rTHA and rTKA consisted of the Hospital Frailty Risk Score (3), CARDE-B index (1), mFI-5 (2), aamFI (1), and a modified MFI (1). Common outcomes reported were mortality within thirty days of the operation (4), readmission within thirty days (3), greater length of stay (2), and any complication within thirty days (2). HFRS was found to be associated with thirty-day readmission and complications. Frailty assessment via the CARDE-B index demonstrated superior capability to predict thirty-day mortality. When compared to the mFI-5, the aamFI showed statistical superiority in its ability to predict thirty-day mortality and complications for both rTHA and rTKA. Conclusion: Frailty assessment as a means of predicting certain outcomes has proven efficacy when applied to the revision arthroplasty. However, due to the lack of comparative analysis in current literature, each has a unique, proven clinical utility without a definitive gold standard for universal assessment. This heterogeneity among frailty scales used for revision total joint arthroplasty has led to inconsistent results and a lack of solidarity, reducing surgeons’ capacity for preoperative optimization and risk stratification.
Abstract
Introduction: The use of frailty indices in orthopedics has grown in popularity to predict surgical outcomes in at-risk populations. While multiple instruments have been used to assess frailty in revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA), there are no comprehensive analyses of the variable indices in this context. The purpose of this study is to thoroughly examine the current landscape of frailty scales used to predict outcomes for rTHA and rTKA. Methods: A comprehensive database search was conducted in accordance with PRISMA guidelines, using the terms: (frailty) AND ("revision" AND ("arthroplasty" OR "knee" OR "hip" OR "joint")). Two blinded reviewers assessed eligibility of studies, conducted a critical appraisal using the Cochrane Risk of Bias, and performed data extraction utilizing a predefined form. Results: There were seven studies which met final inclusion criteria, consisting of 159,594 patients. Included articles utilized national databases (5) and retrospective chart reviews (2). The frailty indices utilized to analyze rTHA and rTKA consisted of the Hospital Frailty Risk Score (3), CARDE-B index (1), mFI-5 (2), aamFI (1), and a modified MFI (1). Common outcomes reported were mortality within thirty days of the operation (4), readmission within thirty days (3), greater length of stay (2), and any complication within thirty days (2). HFRS was found to be associated with thirty-day readmission and complications. Frailty assessment via the CARDE-B index demonstrated superior capability to predict thirty-day mortality. When compared to the mFI-5, the aamFI showed statistical superiority in its ability to predict thirty-day mortality and complications for both rTHA and rTKA. Conclusion: Frailty assessment as a means of predicting certain outcomes has proven efficacy when applied to the revision arthroplasty. However, due to the lack of comparative analysis in current literature, each has a unique, proven clinical utility without a definitive gold standard for universal assessment. This heterogeneity among frailty scales used for revision total joint arthroplasty has led to inconsistent results and a lack of solidarity, reducing surgeons’ capacity for preoperative optimization and risk stratification.
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