Sunshine Bone and Joint Institute, Sunshine Hospitals, Hyderabad, India.
Sunshine Bone and Joint Institute, Sunshine Hospitals, Hyderabad, India.
Knee. 2023 Oct;44:72-78. doi: 10.1016/j.knee.2023.07.009. Epub 2023 Aug 1.
Frailty is an underutilized prognostic parameter in the geriatric population. Our study aimed to analyse the frailty incidence, its transition over 1 year and its influence on complication rate in patients undergoing elective robotic-assisted total knee arthroplasty (TKA).
This was a retrospective study wherein an accumulation of deficits model was used to evaluate frailty of 435 consecutive patients undergoing primary unilateral Mako-assisted cemented TKA between January 2020 and July 2021. Based upon the preoperative values, participants were divided into three groups; non-frail (FI < 0.11), vulnerable (0.11-0.20) and frail (FI > 0.20) states and were followed up for 1 year for change in frailty class, complications, re-admissions and mortality.
A total of 435 patients were divided into three groups, non-frail (178), vulnerable (208) and frail (49). Improvement in mean frailty scores was seen in all three groups (P < 0.0001); 21.63% of the vulnerable and 48.97% of the frail participants improved by one frailty class. Multivariate analysis showed the co-relation of change in frailty index (ΔFI) with preoperative FI (r = 0.083) and Knee Society Score (KSS) (r = 0.742). The frail group had a significantly higher re-admission rate over 1 year. When compared with the vulnerable group, the frail group had a higher hazard ratio for readmission (3.12 vs. 0.96) and complications (1.62 vs. 1.26).
Although frail individuals are at a higher risk for readmissions and perioperative complications, TKA significantly improves the mobility and frailty status of elderly individuals. With explained higher risk of complications, surgeons should not refrain from offering TKA to elderly frail individuals disabled with knee pain.
衰弱是老年人群中未充分利用的预后参数。我们的研究旨在分析接受择期机器人辅助全膝关节置换术（TKA）的患者衰弱的发生率、一年内的变化及其对并发症发生率的影响。
这是一项回顾性研究，使用累积缺陷模型评估 2020 年 1 月至 2021 年 7 月期间接受 Mako 辅助水泥固定单侧初次 TKA 的 435 例连续患者的衰弱情况。根据术前值，患者分为三组；非虚弱（FI<0.11）、脆弱（0.11-0.20）和虚弱（FI>0.20）状态，并随访 1 年以观察虚弱等级、并发症、再入院和死亡率的变化。
435 例患者分为三组，非虚弱（178 例）、脆弱（208 例）和虚弱（49 例）。所有三组的平均衰弱评分均有所改善（P<0.0001）；脆弱组 21.63%和虚弱组 48.97%的患者虚弱等级改善一级。多变量分析显示，衰弱指数（ΔFI）的变化与术前 FI（r=0.083）和膝关节协会评分（KSS）（r=0.742）相关。虚弱组在 1 年内再入院率明显较高。与脆弱组相比，虚弱组的再入院风险更高（3.12 比 0.96），并发症风险更高（1.62 比 1.26）。
尽管虚弱个体再入院和围手术期并发症的风险较高，但 TKA 显著改善了老年患者的活动能力和虚弱状态。由于解释了更高的并发症风险，外科医生不应拒绝为因膝关节疼痛而残疾的老年虚弱个体提供 TKA。
