Skip to main content

Advertisement

SpringerLink
Log in

Clinical Frailty Scale is a better predictor for adverse post-operative complications and functional outcomes than Modified Frailty Index and Charlson Comorbidity Index after total knee arthroplasty

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Studies have demonstrated correlations between frailty and comorbidity scores with adverse outcomes in total knee replacement (TKR). However, there is a lack of consensus on the most suitable pre-operative assessment tool. This study aims to compare Clinical Frailty Scale (CFS), Modified Frailty Index (MFI), and Charlson Comorbidity Index (CCI) in predicting adverse post-operative complications and functional outcomes following a unilateral TKR.

Methods

In total, 811 unilateral TKR patients from a tertiary hospital were identified. Pre-operative variables were age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) class, CFS, MFI, and CCI. Binary logistic regression analysis was performed to ascertain odd ratios of pre-operative variables on adverse post-operative complications (length of stay < LOS >, complications, ICU/HD admission, discharge location, 30-day readmission, 2-year reoperation). Multiple linear regression analyses were used to estimate the standardized effects of pre-operative variables on the Knee Society Functional Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), and 36-Item Short Form Survey (SF-36).

Results

CFS is a strong predictor for LOS (OR 1.876, p < 0.001), complications (OR 1.83–4.97, p < 0.05), discharge location (OR 1.84, p < 0.001), and 2-year reoperation rate (OR 1.98, p < .001). ASA and MFI were predictors for ICU/HD admission (OR:4.04, p = 0.002; OR 1.58, p = 0.022, respectively). None of the scores was predictive for 30-day readmission. A higher CFS was associated with a worse outcome for 6-month KSS, 2-year KSS, 6-month OKS, 2-year OKS, and 6-month SF-36.

Conclusion

CFS is a superior predictor for post-operative complications and functional outcomes than MFI and CCI in unilateral TKR patients. This suggests the importance of assessing pre-operative functional status when planning for TKR.

Level of evidence

Diagnostic, II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Basques BA, Bell JA, Sershon RA, Della Valle CJ (2018) The influence of patient gender on morbidity following total hip or total knee arthroplasty. J Arthroplasty 33:345–349

    Article  PubMed  Google Scholar 

  2. Belmont P, Goodman G, Waterman B, Bader J, Schoenfeld A (2014) Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 96:20–26

    Article  PubMed  Google Scholar 

  3. Bruyère O, Buckinx F, Beaudart C, Reginster J-Y, Bauer J, Cederholm T et al (2017) How clinical practitioners assess frailty in their daily practice: an international survey. Aging Clin Exp Res 29:905–912

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cesari M, Prince M, Thiyagarajan JA, Carvalho IAD, Bernabei R, Chan P et al (2016) Frailty: an emerging public health priority. J Am Med Dir Assoc 17:188–192

    Article  PubMed  Google Scholar 

  5. Cooper Z, Rogers SO, Ngo L, Guess J, Schmitt E, Jones RN et al (2016) A comparison of frailty measures as predictors of outcomes after orthopedic surgery. J Am Geriatr Soc 64:2464–2471

    Article  PubMed  PubMed Central  Google Scholar 

  6. Davies J, Whitlock J, Gutmanis I, Kane S-L (2018) Inter-rater reliability of the retrospectively assigned clinical frailty scale score in a geriatric outreach population. Can Geriatr J 21:1–5

    Article  PubMed  PubMed Central  Google Scholar 

  7. El Bitar Y, Illingworth K, Scaife S, Horberg J, Saleh K (2015) Hospital length of stay following primary total knee arthroplasty: data from the nationwide inpatient sample database. J Arthroplasty 30:1710–1715

    Article  PubMed  Google Scholar 

  8. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 59:255–263

    Article  PubMed  Google Scholar 

  9. Glassou EN, Pedersen AB, Hansen TB (2017) Is decreasing mortality in total hip and knee arthroplasty patients dependent on patients’ comorbidity? Acta Orthop 88:288–293

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gogineni H, Gray C, Prieto H, Deen J, Boezaart A, Parvataneni H (2018) Transition to outpatient total hip and knee arthroplasty: experience at an academic tertiary care center. Arthroplast Today 5:100–105

    Article  PubMed  PubMed Central  Google Scholar 

  11. Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S (2017) Projected increase in total knee arthroplasty in the United States–an alternative projection model. Osteoarthritis Cartilage 25:1797–1803

    Article  CAS  PubMed  Google Scholar 

  12. Kahan BC, Koulenti D, Arvaniti K, Beavis V, Campbell D, Chan M et al (2017) Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. Intensive Care Med 43:971–979

    Article  PubMed  Google Scholar 

  13. Klug A, Gramlich Y, Rudert M, Drees P, Hoffmann R, Weißenberger M et al (2021) The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years. Knee Surg Sports Traumatol Arthrosc 29:3287–3298

    Article  PubMed  Google Scholar 

  14. Lo C, Lee Q, Wong Y (2017) Predictive factors for length of hospital stay following primary total knee replacement in a total joint replacement centre in Hong Kong. Hong Kong Med J 23:435–440

    CAS  PubMed  Google Scholar 

  15. McIsaac DI, Beaule PE, Bryson GL, Van Walraven C (2016) The impact of frailty on outcomes and healthcare resource usage after total joint arthroplasty. Bone Joint J 98:799–805

    Article  PubMed  Google Scholar 

  16. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ et al (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89:1010–1014

    Article  CAS  PubMed  Google Scholar 

  17. Panayi AC, Orkaby AR, Sakthivel D, Endo Y, Varon D, Roh D et al (2019) Impact of frailty on outcomes in surgical patients: a systematic review and meta-analysis. Am J Surg 218:393–400

    Article  CAS  PubMed  Google Scholar 

  18. Parvizi J, Mui A, Purtill JJ, Sharkey PF, William HJ, Rothman RH (2007) Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am 89(1):27–32

    PubMed  Google Scholar 

  19. Podmore B, Hutchings A, van der Meulen J, Aggarwal A, Konan S (2018) Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis. BMJ Open 8:e021784

    Article  PubMed  PubMed Central  Google Scholar 

  20. Quinn T, Gabrial R, Dutton R, Urman R (2017) Analysis of unplanned postoperative admissions to the intensive care unit. J Intensive Care Med 32:436–443

    Article  PubMed  Google Scholar 

  21. Roche M, Law TY, Kurowicki J, Rosas S, Rush AJI (2018) Effect of obesity on total knee arthroplasty costs and revision rate. J Knee Surg 31:38–42

    Article  PubMed  Google Scholar 

  22. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495

    Article  PubMed  PubMed Central  Google Scholar 

  23. Runner RP, Bellamy JL, Vu CCL, Erens GA, Schenker ML, Guild GN (2017) Modified frailty index is an effective risk assessment tool in primary total knee arthroplasty. J Arthroplasty 32:S177–S182

    Article  PubMed  Google Scholar 

  24. Schaeffer JF, Scott DJ, Godin JA, Attarian DE, Wellman SS, Mather RC (2015) The association of ASA class on total knee and total hip arthroplasty readmission rates in an academic hospital. J Arthroplasty 30:723–727

    Article  PubMed  Google Scholar 

  25. Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN (2012) The new knee society knee scoring system. Clin Orthop Relat Res 470:3–19

    Article  PubMed  Google Scholar 

  26. Singh J, Jensen M, Lewallen D (2013) Predictors of periprosthetic fracture after total knee replacement: an analysis of 21,723 cases. Acta Orthop 84:170–177

    Article  PubMed  PubMed Central  Google Scholar 

  27. Singh JA, Yu S, Chen L, Cleveland JD (2019) Rates of total joint replacement in the United States: future projections to 2020–2040 using the national inpatient sample. J Rheumatol 46:1134–1140

    Article  PubMed  Google Scholar 

  28. Springer BD, Levine BR, Golladay GJ (2021) Highlights of the 2020 American Joint Replacement Registry Annual Report. Arthroplast Today 9:141–142

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tay KS, Cher EWL, Zhang K, Tan SB, Howe TS, Koh JSB (2017) Comorbidities have a greater impact than age alone in the outcomes of octogenarian total knee arthroplasty. J Arthroplasty 32:3373–3378

    Article  PubMed  Google Scholar 

  30. Wang HT, Fafard J, Ahern S, Vendittoli PA, Hebert P (2018) Frailty as a predictor of hospital length of stay after elective total joint replacements in elderly patients. BMC Musculoskelet Disord 19:14

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Ware J, Sherbourne C (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  32. Ware JJ, Kosinski M, Bayliss M, McHorney C, Rogers WAR (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 33:AS264–AS279

    PubMed  Google Scholar 

  33. Whitlock KG, Piponov HI, Shah SH, Wang OJ, Gonzalez MH (2016) Gender role in total knee arthroplasty: a retrospective analysis of perioperative outcomes in US patients. J Arthroplasty 31:2736–2740

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by the AM-ETHOS grant [AM-ETHOS01/FY2018/24-A24, 2018].

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore

    Eric Xuan Liu, Punn Kuhataparuks, Ming-Han Lincoln Liow, Hee-Nee Pang, Darren Keng Jin Tay, Shi-lu Chia, Ngai-Nung Lo, Seng-Jin Yeo & Jerry Yongqiang Chen

Authors
  1. Eric Xuan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Punn Kuhataparuks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ming-Han Lincoln Liow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hee-Nee Pang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Darren Keng Jin Tay
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shi-lu Chia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ngai-Nung Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Seng-Jin Yeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jerry Yongqiang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric Xuan Liu.

Ethics declarations

Conflict of interest

No conflict of interest to declare.

Ethical approval

The study was approved by the institutional review board (Institutional review board reference: CIRB 2018/3031).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, E.X., Kuhataparuks, P., Liow, MH.L. et al. Clinical Frailty Scale is a better predictor for adverse post-operative complications and functional outcomes than Modified Frailty Index and Charlson Comorbidity Index after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 3186–3195 (2023). https://doi.org/10.1007/s00167-023-07316-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-023-07316-z

Keywords

Search

Navigation