A Study On Frailty Status Before Operation And Its Effect On Recovery Outcome In Elderly Patients With Unilateral Total Knee Arthroplasty

Objective:To investigate the current situation of preoperative frailty and its influencing factors in elderly patients with knee osteoarthritis?KOA?who underwent unilateral total knee arthroplasty.To explore the effect of preoperative frailty on knee function rehabilitation in elderly patients after unilateral total knee arthroplasty,so as to provide reference for clinical promotion of postoperative knee function rehabilitation of elderly patients.Methods:By use of convenient sampling based on the inclusion criteria,totally 230 elderly patients with KOA who were hospitalized for unilateral total knee arthroplasty were selected from The Affiliated Hospital of Guizhou Medical University,Guizhou Orthopedics Hospital and The Fourth People's Hospital of Guiyang during November 2018 to April 2019.?1?on the day of admission or before surgery,all patients were asked one by one face to face in for general information collection,and the FRAIL Scale,the American Knee Society Score?AKS?,and the Faces Pain Scale-Revised?FPS-R?were used to assess the level of frailty,knee function,and knee pain in elderly patients before surgery,and the preoperative knee flexion was measured by orthopedic protractor.?2?Patients were divided into frailty group and non-frailty group according to the FRAIL score>2and?2.The time of firstly postoperative ambulation,Incidence of early postoperative complications,postoperative use time of walking AIDS,total hospitalization days and total hospitalization costs were recorded to compared between two groups.On the 3^rdand 7^thday after the operation,the orthopedic protractor and the FPS-R were used to measure the postoperative knee flexion and postoperative knee pain.At 2^ndweek,1months,3 months and 6 months after the operation,in addition to continuing to evaluate the degree of postoperative knee pain and measuring postoperative knee flexion,the evaluation of postoperative knee function was increased.?3?Excel was used for data entry and IBM SPSS Statistics 22.0 was adopted to analyzed the data.Depending on the data type,the statistical methods involved in this study include Chi-Square test,independent sample t-test,non-parametric Mann-Whitney U test,Binary Logistic regression analysis,Generalized estimating equation,Spearman correlation test.The level a=0.05.Results:?1?The study finally included 230 cases of unilateral total knee replacement in elderly patients,According to the FRAIL Scale score,preoperative frailty?FRAIL score>2?detection rate was 67.8%?156/230cases?.There were statistically significant differences between the two groups in age,household monthly income per person,hospitalization history in the past six months,whether or not to use walking AIDS,type of walking AIDS,body mass index,duration of knee pain,type of chronic disease,preoperative FPS-R score and preoperative AKS score?P<0.05?.Binary logistic regression showed that household monthly income per person[?2 000yuan:OR=12.598,95%CI?2.771,57.272?,P<0.05;2 001?yuan:OR=5.972,95%CI?1.318,27.053?,P<0.05],BMI[abnormal:OR=3.007,95%CI?1.426,6.339?,P<0.05],duration of knee pain[6?years:OR=2.447,95%CI?1.016,5.895?,P<0.05;11?years:OR=6.072,95%CI?2.257,16.340?,P<0.05;>15years:OR=7.638,95%CI?1.763,33.097?,P<0.05],preoperative FPS-R score[>6score:OR=3.506,95%CI?1.672,7.354?,P<0.05]were the major influential factors for frailty before TKA in elderly KOA patients.?2?By 6 months after the operation,a total of 8 patients were lost to follow-up,and the loss rate was3.5%.The frail group had longer time than the non-frail group at the firstly postoperative ambulation,at the use of walking AIDS after surgery and total hospitalization days,and the Incidence of early postoperative complications and total hospitalization costs were also higher than those in the non-frail group?P<0.05?.The results of the generalized estimation equation showed that,after adjusting for factors such as household monthly income per person,BMI,duration of knee pain,and preoperative FPS-R score,the FPS-R score of knee pain at different time points after TKA was higher in the frail group than in the non-frail group??=0.905,95%CI:0.574?1.236;P<0.001?,knee flexion??=-7.094,95%CI:-9.081?-5.107;P<0.001?and and knee function AKS scores were lower??=-4.033,95%CI:-5.601?-2.465;P<0.001?.Spearman correlation analysis showed that preoperative FRAIL score was positively correlated with postoperative knee FPS-R pain score and negatively correlated with postoperative knee flexion and knee function AKS score at different measurement time points?P<0.001?.Conclusion:?1?The prevalence of preoperative frailty in elderly patients with knee osteoarthritis who underwent unilateral total knee arthroplasty was at a high level,and it was also susceptible to multiple factors including household monthly income per person,BMI,duration of knee pain and pain degree.?2?The preoperative frailty has showed negative influence on the recovery process of the joint function after TKA,which could enhance postoperative knee pain and delay the recovery of knee flexion function.At the same time,it increases the risk of early postoperative complications,prolongates the time of firstly postoperative ambulation,the time of postoperative use of walking AIDS and the length of hospital stay,and increases the total cost of hospital stay.