ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2023
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.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Impact of frailty on outcomes of pancreatic surgery: a systematic review and meta-analysis.Frontiers in nutrition · 2026Pooled it
- Orthopedic frailty risk stratification (OFRS): a systematic review of the frailty indices predicting adverse outcomes in orthopedics.Journal of orthopaedic surgery and research · 2025Pooled it
- Motor-Sparing Regional Analgesia in Frail and Sarcopenic Older Adults Undergoing Total Knee Arthroplasty: From Anatomy to Clinical Decision-Making-A Narrative Review.Journal of clinical medicine · 2026Review
- Can frailty predict complications and mortality in patients undergoing total knee arthroplasty? A systematic review and meta-analysis.Pakistan journal of medical sciences · 2026Article
- Inflammatory Biomarkers Following Orthopedic Surgery: Current Evidence, Clinical Applications, and Future Perspectives-A Narrative Review.Journal of clinical medicine · 2026Review
- The Prognostic Value of Frailty Assessment Tools in Predicting Postoperative Outcomes After Revision Total Hip and Knee Arthroplasty: A Systematic Review.Journal of clinical medicine · 2026Review
- Association between preoperative frailty to adverse postoperative outcomes in older people undergoing elective spinal surgery: a prospective cohort study.BMC geriatrics · 2025Article
- Predictive analysis of economic and clinical outcomes in total knee arthroplasty: Identifying high-risk patients for increased costs and length of stay.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- The clinical frailty scale is associated with an increased risk of postoperative complications and the development of post-traumatic osteoarthritis in elderly patients with trimalleolar ankle fractures - a retrospective study.Journal of orthopaedic surgery and research · 2025Article
- Observational
- Good Mid-Term Implant Survival of a Novel Single-Design Rotating-Hinge Total Knee Arthroplasty.Journal of clinical medicine · 2023Article
- Assessing the Clinical Usefulness and Transparency of Knee Arthroplasty Randomized Controlled Trials (2020-2024): A Systematic Review Using the van't Hooft Framework.JB & JS open accessReview
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Authors and funding
9 authors.
Funding
Abstract
purposeStudies 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.
methodsIn 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).
resultsCFS 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.
conclusionCFS 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.
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