Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN; Department of Health Sciences and Research, Mayo Clinic, Rochester, MN.
J Arthroplasty. 2022 Jan;37(1):10-18.e2. doi: 10.1016/j.arth.2021.08.022. Epub 2021 Sep 1.
Total joint arthroplasty (TJA) is prevalent and offered to patients regardless of frailty status experiencing pain, disability, and functional decline. This study aims to describe changes in levels of frailty 1 year after TJA.
We identified a retrospective cohort of adult patients undergoing primary TJA between 2005 and 2016 using an institutional total joint registry. Associations between categorized frailty deficit index (FI) and change in FI were analyzed using linear regression models. Mortality, deep periprosthetic joint infection, and reoperation were analyzed using time to event methods.
In total, 5341 patients (37.6% non-frail, 39.4% vulnerable, and 23.0% frail) with items necessary to determine FI at 1 year after TJA were included. Preoperatively, 29% of vulnerable patients improved to non-frail 1 year later, compared to only 11% regressing to frail. Four in 10 frail patients improved to vulnerable/non-frail. Improvements in activities of daily living (ADL) were more evident in frail and vulnerable patients, with >30% reduction in the percentage of patients expressing difficulties with walking, climbing stairs, and requiring ADL assistance 1 year after TJA. Increases in frailty 1 year after TJA were associated with significantly increased rates of mortality (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.24-1.82, P < .001), deep periprosthetic joint infection (HR 3.98, 95% CI 1.85-8.58, P < .001), and reoperation (HR 1.80, 95% CI 1.19-2.72, P = .005).
Frailty states are dynamic with patient frailty shown to be modifiable 1 year after TJA. Preoperative frailty measurement is an important step toward identifying those that may benefit most from TJA and for postoperative frailty surveillance.
全关节置换术（TJA）普遍应用于患有疼痛、残疾和功能下降的患者，无论其虚弱状态如何。本研究旨在描述 TJA 后 1 年患者虚弱程度的变化。
我们使用机构性全关节登记处，确定了 2005 年至 2016 年期间接受初次 TJA 的成人患者的回顾性队列。使用线性回归模型分析分类虚弱缺陷指数（FI）与 FI 变化之间的关联。使用时间事件方法分析死亡率、深部假体周围关节感染和再次手术。
共纳入 5341 例患者（37.6%非虚弱，39.4%脆弱，23.0%虚弱），这些患者在 TJA 后 1 年需要进行 FI 项目确定。术前，29%的脆弱患者在 1 年后改善为非虚弱，而只有 11%的患者恶化到虚弱。40%的虚弱患者改善为脆弱/非虚弱。日常生活活动（ADL）的改善在虚弱和脆弱患者中更为明显，超过 30%的患者在 TJA 后 1 年内表示行走、爬楼梯和需要 ADL 帮助的难度降低。TJA 后 1 年时的 FI 增加与死亡率（风险比[HR]1.50，95%置信区间[CI]1.24-1.82，P<.001）、深部假体周围关节感染（HR 3.98，95%CI 1.85-8.58，P<.001）和再次手术（HR 1.80，95%CI 1.19-2.72，P<.005）显著增加相关。
虚弱状态是动态的，TJA 后患者的虚弱程度可改变。术前虚弱测量是识别最有可能从 TJA 中受益并进行术后虚弱监测的重要步骤。
