{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T03:54:08Z","timestamp":1790135648476,"version":"4.0.1"},"reference-count":36,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Frailty is a key predictor of adverse surgical outcomes in older adults. However, the prognostic utility of the 5-factor modified frailty index (mFI-5) for short- and long-term outcomes following total hip arthroplasty (THA) remains inadequately defined. This study assessed the association between frailty severity, measured by the mFI-5, and postoperative complications, implant survivorship, and mortality following primary THA in a large national cohort. Methods: This retrospective cohort study included 90,660 patients aged \u226550 years undergoing primary THA for osteoarthritis from 2003 to 2020 using the TriNetX research network. Patients were stratified by frailty severity based on mFI-5 scores: non-frail (0\u20131), moderately frail (2), and severely frail (\u22653). Cases of fractures, polytrauma, or falls were excluded. Pairwise propensity score matching was adjusted for age, sex, race, and BMI. Outcomes included 90-day medical and surgical complications, healthcare utilization, and 2- and 5-year THA revision and mortality rates. Risk ratios (RRs) with 95% confidence intervals (CIs) and Bonferroni-corrected significance thresholds (p &lt; 0.0167) were reported. Results: Severely frail patients had significantly increased risks of 90-day mortality (RR 4.41, 95% CI 2.22\u20138.74), acute kidney injury (RR 2.92), myocardial infarction (RR 3.61), and periprosthetic joint infection (RR 2.02) compared to non-frail patients. At five years, severely frail patients demonstrated a 58% higher revision risk (RR 1.58) and 23.0% mortality versus 6.9% in the non-frail cohort. A dose-dependent risk gradient was observed, with moderately frail patients exhibiting intermediate risks across all outcomes. Conclusions: Frailty severity, as measured by the mFI-5, was associated with a stepwise increase in short- and long-term complications and mortality following THA. The mFI-5 may serve as a practical, scalable tool for preoperative risk stratification, counseling, and resource planning in older adults undergoing primary THA.<\/jats:p>","DOI":"10.3390\/jcm15072802","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T14:00:31Z","timestamp":1775570431000},"page":"2802","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Influence of Frailty on Total Hip Arthroplasty Outcomes: A Propensity-Matched Study of 90,660 Patients Using the Modified Frailty Index"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8090-4575","authenticated-orcid":false,"given":"Sri","family":"Tummala","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA"},{"name":"Department of Medical Education, Texas A&M School of Medicine, Baylor University Medical Center, 3500 Gaston Avenue, 6-Roberts, Dallas, TX 75246, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8837-0396","authenticated-orcid":false,"given":"Mehul M.","family":"Mittal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9988-4165","authenticated-orcid":false,"given":"Hetsinhji","family":"Chavda","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Texas A&M School of Medicine, Baylor University Medical Center, 3500 Gaston Avenue, 6-Roberts, Dallas, TX 75246, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun R.","family":"Sontam","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Texas A&M School of Medicine, Baylor University Medical Center, 3500 Gaston Avenue, 6-Roberts, Dallas, TX 75246, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senthil N.","family":"Sambandam","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3637-6208","authenticated-orcid":false,"given":"Dane K.","family":"Wukich","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA"},{"name":"Department of Prosthetics and Orthotics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1186\/s13018-025-05826-9","article-title":"Correction: The modifed 5-item frailty index in total hip arthroplasty patients: A retrospective cohort from a low-middle income country","volume":"20","author":"Ali","year":"2025","journal-title":"J. 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