{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T03:39:30Z","timestamp":1792121970132,"version":"4.4.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T00:00:00Z","timestamp":1672012800000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","award":["PSTRC-2016-003"],"award-info":[{"award-number":["PSTRC-2016-003"]}],"id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012041","name":"Versus Arthritis","doi-asserted-by":"publisher","award":["21,755"],"award-info":[{"award-number":["21,755"]}],"id":[{"id":"10.13039\/501100012041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>to determine the impact of frailty on patient-reported outcomes following hip and knee arthroplasty.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>we used linked primary and secondary care electronic health records. Frailty was assessed using the electronic frailty index (categorised: fit, mild, moderate, severe frailty). We determined the association between frailty category and post-operative Oxford hip\/knee score (OHS\/OKS) using Tobit regression. We calculated the proportion of patients in each frailty category who achieved the minimally important change (MIC) in OHS (\u22658 points) and OKS (\u22657 points) and the proportion who reported a successful outcome (hip\/knee problems either \u2018much better\u2019 or \u2018a little better\u2019 following surgery).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>About 42,512 people who had a hip arthroplasty and 49,208 who had a knee arthroplasty contributed data. In a Tobit model adjusted for pre-operative OHS\/OKS, age, sex and quintile of index of multiple deprivation, increasing frailty was associated with decreasing post-operative OHS and OKS, respectively, \u03b2-coefficient (95% CI) in severely frail versus fit, \u22126.97 (\u22127.44, \u22126.49) and\u2009\u2212\u20095.88 (\u22126.28, \u22125.47). The proportion of people who achieved the MIC in OHS and OKS, respectively, decreased from 92 and 86% among fit individuals to 84 and 78% among those with severe frailty. Patient-reported success following hip and knee arthroplasty, respectively, decreased from 97 and 93% among fit individuals to 90 and 83% among those with severe frailty.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>frailty adversely impacts on patient-reported outcomes following hip and knee arthroplasty. However, even among those with severe frailty, the large majority achieved the MIC in OHS\/OKS and reported a successful outcome.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afac288","type":"journal-article","created":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T16:49:14Z","timestamp":1672073354000},"source":"Crossref","is-referenced-by-count":22,"title":["The impact of frailty on patient-reported outcomes following hip and knee arthroplasty"],"prefix":"10.1093","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6551-9722","authenticated-orcid":false,"given":"Michael J","family":"Cook","sequence":"first","affiliation":[{"name":"University of Manchester Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, , Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lunt","sequence":"additional","affiliation":[{"name":"University of Manchester Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, , Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren M","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"University of Manchester Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Science Centre, , Manchester UK"},{"name":"University of Manchester NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, , Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Board","sequence":"additional","affiliation":[{"name":"Wrightington Hospital Department of Trauma and Orthopaedic Surgery, , Wigan, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terence W","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"University of Manchester Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, , Manchester, UK"},{"name":"Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre NIHR Manchester Biomedical Research Centre, , Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,12,19]]},"reference":[{"key":"2022122616012216900_ref1","doi-asserted-by":"crossref","first-page":"215145931983510","DOI":"10.1177\/2151459319835109","article-title":"The impact of frailty on short-term outcomes after elective hip and knee arthroplasty in older adults: a systematic review","volume":"10","author":"Schmucker","year":"2019","journal-title":"Geriatr Orthop Surg Rehabil"},{"key":"2022122616012216900_ref2","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.arth.2018.09.078","article-title":"Impact of frailty on outcomes after primary and revision total hip arthroplasty","volume":"34","author":"Johnson","year":"2019","journal-title":"J Arthroplasty"},{"key":"2022122616012216900_ref3","doi-asserted-by":"crossref","first-page":"3498","DOI":"10.1016\/j.arth.2020.06.087","article-title":"Hospital frailty risk score predicts adverse events in primary total hip and knee arthroplasty","volume":"35","author":"Meyer","year":"2020","journal-title":"J Arthroplasty"},{"key":"2022122616012216900_ref4","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afac118","article-title":"The impact of frailty on short-term mortality following primary total hip and knee arthroplasty due to osteoarthritis","volume":"51","author":"Cook","year":"2022","journal-title":"Age Ageing"},{"key":"2022122616012216900_ref5","doi-asserted-by":"crossref","first-page":"213","DOI":"10.5114\/reum.2020.98433","article-title":"Modified frailty index as a predictor of the long-term functional result in patients undergoing primary total hip arthroplasty","volume":"58","author":"Pulik","year":"2020","journal-title":"Reumatologia\/Rheumatology"},{"key":"2022122616012216900_ref6","doi-asserted-by":"crossref","first-page":"2151459318808164","DOI":"10.1177\/2151459318808164","article-title":"Frailty questionnaire is not a strong prognostic factor for functional outcomes in hip or knee arthroplasty patients","volume":"10","author":"Meessen","year":"2019","journal-title":"Geriatr Orthop Surg Rehabi"},{"key":"2022122616012216900_ref8","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1177\/0141076816677856","article-title":"Reflections on the national patient-reported outcome measures (PROMs) programme: where do we go from here?","volume":"109","author":"Kyte","year":"2016","journal-title":"J R Soc Med"},{"key":"2022122616012216900_ref9","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1302\/0301-620X.104B6.BJJ-2021-1577.R1","article-title":"Early patient-reported outcomes from primary hip and knee arthroplasty have improved over the past seven years","volume":"104-B","author":"Sabah","year":"2022","journal-title":"Bone Joint J"},{"key":"2022122616012216900_ref10","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jclinepi.2014.08.009","article-title":"Meaningful changes for the Oxford hip and knee scores after joint replacement surgery","volume":"68","author":"Beard","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"2022122616012216900_ref11","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1302\/0301-620X.94B3.27425","article-title":"Interpretation of patient-reported outcomes for hip and knee replacement surgery: identification of thresholds associated with satisfaction with surgery","volume":"94-B","author":"Judge","year":"2012","journal-title":"J Bone Joint Surg"},{"key":"2022122616012216900_ref12","doi-asserted-by":"crossref","first-page":"e046712","DOI":"10.1136\/bmjopen-2020-046712","article-title":"Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England","volume":"11","author":"Ferguson","year":"2021","journal-title":"BMJ Open"},{"key":"2022122616012216900_ref13","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/ije\/dyv098","article-title":"Data resource profile: clinical practice research datalink (CPRD)","volume":"44","author":"Herrett","year":"2015","journal-title":"Int J Epidemiol"},{"key":"2022122616012216900_ref14","doi-asserted-by":"crossref","first-page":"1740g","DOI":"10.1093\/ije\/dyz034","article-title":"Data resource profile: clinical practice research datalink (CPRD) Aurum","volume":"48","author":"Wolf","year":"2019","journal-title":"Int J Epidemiol"},{"key":"2022122616012216900_ref15","doi-asserted-by":"crossref","first-page":"1093i","DOI":"10.1093\/ije\/dyx015","article-title":"Data resource profile: hospital episode statistics admitted patient care (HES APC)","volume":"46","author":"Herbert","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2022122616012216900_ref16","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/ageing\/afw039","article-title":"Development and validation of an electronic frailty index using routine primary care electronic health record data","volume":"45","author":"Clegg","year":"2016","journal-title":"Age Ageing"},{"key":"2022122616012216900_ref17","volume-title":"Read Version 2 to SNOMED CT Mapping Tables 2020","author":"NHS Digital"},{"key":"2022122616012216900_ref18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1093\/ageing\/afy162","article-title":"Convergent validity of the electronic frailty index","volume":"48","author":"Brundle","year":"2019","journal-title":"Age Ageing"},{"key":"2022122616012216900_ref19","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1093\/ageing\/afz110","article-title":"External validation of the electronic frailty index using the population of Wales within the secure anonymised information linkage databank","volume":"48","author":"Hollinghurst","year":"2019","journal-title":"Age Ageing"},{"key":"2022122616012216900_ref20","volume-title":"Patient Reported Outcome Measures (PROMs).","author":"NHS Digital"},{"key":"2022122616012216900_ref21","volume-title":"National Joint Registry 18th Annual Report 2021","author":"NJR Editorial Board"},{"key":"2022122616012216900_ref22","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1302\/0301-620X.78B2.0780185","article-title":"Questionnaire on the perceptions of patients about total hip replacement","volume":"78B","author":"Dawson","year":"1996","journal-title":"J Bone Joint Surg"},{"key":"2022122616012216900_ref23","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1302\/0301-620X.80B1.0800063","article-title":"Questionnaire on the perceptions of patients about total knee replacement","volume":"80","author":"Dawson","year":"1998","journal-title":"J Bone Joint Surg"},{"key":"2022122616012216900_ref24","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jclinepi.2021.12.016","article-title":"Minimal important changes and differences were estimated for Oxford hip and knee scores following primary and revision arthroplasty","volume":"143","author":"Sabah","year":"2022","journal-title":"J Clin Epidemiol"},{"key":"2022122616012216900_ref25","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1302\/2046-3758.311.2000313","article-title":"Can pain and function be distinguished in the Oxford hip score in a meaningful way?","volume":"3","author":"Harris","year":"2014","journal-title":"Bone Joint Res"},{"key":"2022122616012216900_ref26","doi-asserted-by":"crossref","first-page":"2561","DOI":"10.1007\/s11136-013-0393-x","article-title":"Can pain and function be distinguished in the Oxford knee score in a meaningful way? An exploratory and confirmatory factor analysis","volume":"22","author":"Harris","year":"2013","journal-title":"Qual Life Res"},{"key":"2022122616012216900_ref27","doi-asserted-by":"crossref","DOI":"10.3310\/pgfar05120","article-title":"Lower limb arthroplasty: can we produce a tool to predict outcome and failure, and is it cost-effective?","author":"Arden","year":"2017"},{"key":"2022122616012216900_ref28","first-page":"2015","article-title":"UK indices of multiple deprivation\u2014a way to make comparisons across constituent countries easier","volume":"53","author":"Payne","year":"2012","journal-title":"Health Stat Q"},{"key":"2022122616012216900_ref29","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1177\/0016986210379095","article-title":"Modeling outcomes with floor or ceiling effects: an introduction to the Tobit model","volume":"54","author":"McBee","year":"2010","journal-title":"Gift Child Q"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/51\/12\/afac288\/48179433\/afac288.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/51\/12\/afac288\/48179433\/afac288.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T16:49:31Z","timestamp":1672073371000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/doi\/10.1093\/ageing\/afac288\/6936399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":28,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12,5]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afac288","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,12]]},"published":{"date-parts":[[2022,12]]},"article-number":"afac288"}}