Frailty Predicts Postoperative Risk Following Total Joint Arthroplasty in Patients With Metastatic Disease
Aruni Areti, Rohan Rajan, Brett Barthman, Victor Koltenyuk, Hikmat Chmait, Cameron Sabet, Lucas Marchese, Tyler Williamson, Taylor J. Manes, Benjamin C. Taylor, Jack WeickIntroduction
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) can relieve end-stage arthritis and pain in patients with metastatic disease, but this population faces increased perioperative risk because of malignancy and treatment-related immunosuppression. Frailty indices such as the 5-Factor Modified Frailty Index (mFI-5) and Risk Analysis Index (RAI) may improve preoperative risk stratification. This study compared their ability to predict postoperative outcomes after primary THA/TKA.
Methods
The ACS-NSQIP database (2015-2020) was reviewed for patients with metastatic disease undergoing primary THA or TKA. Frailty scores were calculated using RAI and mFI-5. Multivariable regression estimated odds ratios (ORs) for adverse outcomes, and discriminatory accuracy was assessed with area under the curve (AUC).
Results
Among 1115 patients (median age 69 years), median length of stay was 2 days, 4.9% had major complications, and 22.6% required non-home discharge. RAI independently predicted extended length of stay and non-home discharge and showed the strongest discrimination for mortality. mFI-5 predicted 30-day readmission and modestly outperformed RAI for this outcome. Procedure-specific analyses showed RAI best predicted mortality after THA and extended length of stay after TKA. Overall, both indices demonstrated only modest discrimination.
Conclusion
Frailty assessment may improve risk stratification in metastatic patients undergoing primary THA/TKA.