Background
Methods
Study design
Data collection
Study population
Surgical techniques and implants
Assessment of frailty
Additional study variables
Statistical analysis
Results
Baseline characteristics
Characteristics | Total (n = 101) | Pre-frail (n = 50) | Frail (n = 51) |
---|---|---|---|
Female n (%) | 71 (70.30) | 29 (58.00) | 42 (82.35) |
Age y, mean ± SD | 78.52 ± 4.51 | 76.98 ± 4.20 | 80.04 ± 4.33 |
BMI kg/m² mean ± SD | 28.99 ± 4.74 | 28.10 ± 4.14 | 29.86 ± 5.16 |
Medication n mean ± SD | 7.70 ± 3.78 | 7.10 ± 3.82 | 8.29 ± 3.67 |
Comorbidities n mean ± SD | 7.53 ± 3.13 | 7.50 ± 2.98 | 7.57 ± 3.31 |
CCI mean ± SD | 5.45 ± 1.94 | 5.16 ± 1.96 | 5.73 ± 1.89 |
NRS score (0–7) mean ± SD | 1.28 ± 0.78 | 1.20 ± 0.61 | 1.35 ± 0.91 |
Barthel Index (0-100) mean ± SD | 92.03 ± 12.47 | 95.90 ± 5.41 | 88.24 ± 15.90 |
IADL score (0–8) mean ± SD | 6.69 ± 1.67 | 7.26 ± 1.24 | 6.14 ± 1.85 |
SPPB score (0–12) mean ± SD | 6.66 ± 2.64 | 8.36 ± 2.01 | 5.00 ± 2.08 |
MMSE score (0–30) mean ± SD | 26.95 ± 2.34 | 27.22 ± 2.25 | 26.69 ± 2.42 |
GDS-15 score (0–15) mean ± SD | 3.49 ± 2.92 | 2.90 ± 2.87 | 4.06 ± 2.89 |
General improvement in frailty after THA/TKA
Frailty scores at the different measurement times
Total sample (Hip and knee patients) | Total (n = 101) | Pre-frail (n = 50) | Frail (n = 51) |
Frailty score pre-op (t0) | 2.49 ± 1.05 | 1.56 ± 0.50 | 3.39 ± 1.45 |
Frailty score d 7 post-op (t1) | 2.12 ± 1.43 | 1.90 ± 1.40 | 2.33 ± 1.44 |
Frailty score 4–6 wk follow-up (t2) | 1.39 ± 1.39 | 0.88 ± 1.17 | 1.78 ± 1.45 |
Frailty score 12 wk follow-up (t3) | 0.91 ± 1.17 | 0.53 ± 0.73 | 1.27 ± 1.14 |
Hip patients | Total (n = 65) | Pre-frail (n = 26) | Frail (n = 39) |
Frailty score pre-op (t0) | 2.63 ± 1.02 | 1.54 ± 0.51 | 3.36 ± 0.49 |
Frailty score d 7 post-op (t1) | 2.15 ± 1.46 | 2.11 ± 1.56 | 2.18 ± 1.41 |
Frailty score 4–6 wk follow-up (t2) | 1.44 ± 1.44 | 1.08 ± 1.44 | 1.71 ± 1.39 |
Frailty score 12 wk follow-up (t3) | 0.85 ± 1.09 | 0.50 ± 0.86 | 1.08 ± 1.18 |
Knee patients | Total (n = 36) | Pre-frail (n = 24) | Frail (n = 12) |
Frailty score pre-op (t0) | 2.22 ± 1.05 | 1.58 ± 0.50 | 3.50 ± 0.52 |
Frailty score d 7 post-op (t1) | 2.06 ± 1.39 | 1.67 ± 1.20 | 2.83 ± 1.47 |
Frailty score 4–6 wk follow-up (t2) | 1.11 ± 1.28 | 0.65 ± 0.71 | 2.00 ± 1.65 |
Frailty score 12 wk follow-up (t3) | 1.03 ± 1.32 | 0.57 ± 0.73 | 1.92 ± 1.73 |
Results of rmANOVA tests
Total sample | |||||
Effect | df | MSE | F | ges | p.value |
Time | 2.61, 255.95 | 0.99 | 58.78 | 0.193 | < 0.001 |
contrast | estimate | SE | df | t.ratio | p.value |
pre-op (t0) - d7 post-op (t1) | 0.364 | 0.157 | 98 | 2.317 | 0.135 |
pre-op (t0) − 4–6 wk post-op (t2) | 1.152 | 0.136 | 98 | 8.484 | < 0.001 |
pre-op (t0) − 12 wk post-op (t3) | 1.566 | 0.124 | 98 | 12.663 | < 0.001 |
d7 post-op (t1) − 4–6 wk post-op (t2) | 0.788 | 0.124 | 98 | 6.367 | < 0.001 |
d7 post-op (t1) − 12 wk post-op (t3) | 1.202 | 0.143 | 98 | 8.415 | < 0.001 |
4–6 wk post-op (t2) − 12 wk post-op (t3) | 0.414 | 0.103 | 98 | 4.039 | < 0.001 |
P value adjustment: bonferroni method for 6 tests | |||||
Pre-frail | |||||
Effect | df | MSE | F | ges | p.value |
Time | 2.31, 110.87 | 0.95 | 25.36 | 0.215 | < 0.001 |
contrast | estimate | SE | df | t.ratio | p.value |
pre-op (t0) - d7 post-op (t1) | -0.327 | 0.209 | 48 | -1.562 | 0.749 |
pre-op (t0) − 4–6 wk post-op (t2) | 0.673 | 0.183 | 48 | 3.680 | 0.004 |
pre-op (t0) − 12 wk post-op (t3) | 1.020 | 0.135 | 48 | 7.549 | < 0.001 |
d7 post-op (t1) − 4–6 wk post-op (t2) | 1.000 | 0.152 | 48 | 6.600 | < 0.001 |
d7 post-op (t1) − 12 wk post-op (t3) | 1.347 | 0.197 | 48 | 6.844 | < 0.001 |
4–6 wk post-op (t2) − 12 wk post-op (t3) | 0.347 | 0.147 | 48 | 2.354 | 0.136 |
P value adjustment: bonferroni method for 6 tests | |||||
Frail | |||||
Effect | df | MSE | F | ges | p.value |
Time | 2.71, 132.75 | 0.92 | 49.06 | 0.286 | < 0.001 |
contrast | estimate | SE | df | t.ratio | p.value |
pre-op (t0) - d7 post-op (t1) | 1.04 | 0.192 | 49 | 5.429 | < 0.001 |
pre-op (t0) − 4–6 wk post-op (t2) | 1.62 | 0.178 | 49 | 9.092 | < 0.001 |
pre-op (t0) − 12 wk post-op (t3) | 2.10 | 0.177 | 49 | 11.884 | < 0.001 |
d7 post-op (t1) − 4–6 wk post-op (t2) | 0.58 | 0.192 | 49 | 3.023 | 0.024 |
d7 post-op (t1) − 12 wk post-op (t3) | 1.06 | 0.207 | 49 | 5.125 | < 0.001 |
4–6 wk post-op (t2) − 12 wk post-op (t3) | 0.48 | 0.144 | 49 | 3.344 | 0.010 |
P value adjustment: bonferroni method for 6 tests |
Impact on frailty stages
Fried frailty phenotype subscores for the total study group (THA/TKA)
Exclusion of confounding factors in the improvement of frailty
Univariate | Multivariate | |
---|---|---|
(Intercept) | 1.65 *** | |
[0.99, 2.31] | ||
Age | -0.10 | -0.04 |
[-0.60, 0.39] | [-0.60, 0.52] | |
Gender (0 = female) | -0.56 | -0.65 |
[-1.58, 0.46] | [-1.78, 0.49] | |
BMI | 0.13 | -0.03 |
[-0.38, 0.63] | [-0.60, 0.54] | |
SPPB-Score | 0.10 | 0.04 |
[-0.39, 0.60] | [-0.60, 0.68] | |
GDS-Score | -0.38 | -0.38 |
[-0.83, 0.07] | [-0.90, 0.14] | |
NRS-Score | -0.03 | 0.01 |
[-0.51, 0.45] | [-0.52, 0.54] |