Fragility significantly correlated with complications after TKA
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According to study results, one-fifth of patients who underwent primary and revision total knee arthroplasty were classified as frail and were at a significantly higher risk for complications.
Researchers used multivariable logistic and Cox regression analyses to determine whether the frailty deficit index adjusted for age predicts outcomes before hospital discharge and within 90 and 365 days of TKA.
“Frailty is a major public health burden,” study co-author Rebecca L. Johnson, MD, an anesthesiologist at Mayo Clinic in Rochester, Minnesota, told Healio.com/Orthopedics. “We found that almost one-fifth of patients undergoing total knee arthroplasty, a very common orthopedic surgery, are frail and at notable risk for complications including reoperation, fractures of the operative leg, wound complications, infection and death within the first year after surgery.”
She added, “It is important that providers calculate a preoperative frailty index measure in order to better guide shared decision-making conversations, optimize the health of patients before surgery and for use in monitoring patients at heighted risk for poor outcomes.”
Johnson and colleagues identified 7,920 patients who underwent primary TKA and 1,898 patients who underwent revision TKA. Investigators classified 21% of patients who underwent TKA as frail, 39% of patients as vulnerable and 40% of patients as non-frail. Frail patients compared with non-frail patients had more systemic diseases and were more often women. Investigators noted that during hospital stay, frail patients had an increased chance for reoperation and wound complications/hematoma.
According to researchers, after age was adjusted, they found an increased chance for periprosthetic fracture and mortality within 90 days after TKA. Frail patients within the first year after TKA were at a higher risk for death, any patient infection, wound complications/hematoma, periprosthetic fracture and reoperation. No significant correlations were seen with arthrofibrosis, aseptic loosening or patellar clunk syndrome at any time. – by Monica Jaramillo
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Johnson RL, et al. Orthopedics.2019;doi:10.3928/01477447-20190812-05.
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