{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T03:54:36Z","timestamp":1790135676880,"version":"4.0.1"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"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>Introduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) volumes continue to rise, yet postoperative functional recovery and physical therapy (PT) utilization remain highly variable. Frailty and sarcopenia capture biological vulnerability beyond chronological age and may better explain heterogeneity in rehabilitation needs and recovery trajectories. Methods: We conducted a qualitative narrative review guided by SANRA recommendations. PubMed, Scopus, Web of Science, CINAHL, and Google Scholar were searched for English-language studies (January 2000\u2013December 2025) involving adults undergoing THA\/TKA that assessed preoperative frailty and\/or sarcopenia and reported postoperative functional or rehabilitation-related outcomes. Data were extracted and synthesized thematically without quantitative pooling. Results: Thirty-four studies met inclusion criteria. Despite heterogeneous definitions and measures, both frailty and sarcopenia were consistently associated with slower early mobility, poorer functional recovery, longer hospital stays, and higher rates of non-home discharge. Frailty showed stronger links to post-acute care use and healthcare costs, whereas sarcopenia was more closely tied to impaired early function, delayed ambulation, and greater reliance on assistive devices. Frailty may improve after arthroplasty in some patients, while sarcopenia often represents a more persistent, muscle-specific limitation. Direct reporting of PT dose was uncommon, with only a minority of included studies explicitly reporting physical therapy frequency, duration, or intensity, limiting the ability to assess dose\u2013response relationships. Conclusions: Preoperative frailty and sarcopenia are clinically meaningful predictors of functional recovery and rehabilitation utilization after THA\/TKA and support vulnerability-informed discharge planning and stratified rehabilitation pathways. Future prospective studies should standardize vulnerability assessment and directly quantify PT dose, setting, and patient-centered outcomes to inform and test vulnerability-guided rehabilitation strategies, including prehabilitation.<\/jats:p>","DOI":"10.3390\/jcm15103578","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:15:07Z","timestamp":1778156107000},"page":"3578","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Frailty and Sarcopenia as Predictors of Functional Recovery After Total Hip and Knee Arthroplasty: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2827-3740","authenticated-orcid":false,"given":"Man","family":"Hung","sequence":"first","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA"},{"name":"Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT 84108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6387-135X","authenticated-orcid":false,"given":"Annabella","family":"Jensen","sequence":"additional","affiliation":[{"name":"William Beaumont School of Medicine, Oakland University, Rochester, MI 48309, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Strickler","sequence":"additional","affiliation":[{"name":"William Beaumont School of Medicine, Oakland University, Rochester, MI 48309, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Vu","sequence":"additional","affiliation":[{"name":"Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Hon","sequence":"additional","affiliation":[{"name":"Department of Economics, University of Chicago, Chicago, IL 60637, USA"},{"name":"Idaho College of Osteopathic Medicine, Meridian, ID 83642, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avianna","family":"Arapovic","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Corewell Health, Royal Oak, MI 48073, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mouhanad M.","family":"El-Othmani","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School, Brown University, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Groot, L., Latijnhouwers, D.A.J.M., Reijman, M., Verdegaal, S.H.M., Vlieland, T.P.M.V., Gademan, M.G.J., on behalf of the Longitudinal Leiden Orthopaedics Outcomes of Osteoarthritis Study (LOAS) Group, Nelissen, R.G.H.H., van der Linden, H.M.J., and Kaptein, B.L. (2022). Recovery and the use of postoperative physical therapy after total hip or knee replacement. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05429-z"},{"key":"ref_2","unstructured":"Medical Advisory Secretariat (2005). Physiotherapy rehabilitation after total knee or hip replacement: An evidence-based analysis. Ont. Health Technol. Assess. Ser., 5, 1\u201391."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2151459319835109","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":"ref_4","doi-asserted-by":"crossref","first-page":"S182","DOI":"10.1016\/j.arth.2023.02.036","article-title":"Frailty is associated with increased complication, readmission, and hospitalization costs following primary total knee arthroplasty","volume":"38","author":"Lakra","year":"2023","journal-title":"J. Arthroplast."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1038\/s41413-025-00455-8","article-title":"Research progress on sarcopenia in the musculoskeletal system","volume":"13","author":"Mao","year":"2025","journal-title":"Bone Res."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Longo, U.G., De Salvatore, S., Borredon, A., Manon, K.Y., Marchetti, A., De Marinis, M.G., and Denaro, V. (2023). The effects of sarcopenia on hip and knee replacement surgery: A systematic review. Medicina, 59.","DOI":"10.3390\/medicina59030524"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1759720X21998508","DOI":"10.1177\/1759720X21998508","article-title":"Impact of sarcopenia on rehabilitation outcomes after total knee replacement in older adults with knee osteoarthritis","volume":"13","author":"Liao","year":"2021","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1007\/s00198-012-1913-1","article-title":"Frailty and sarcopenia: Definitions and outcome parameters","volume":"23","author":"Cooper","year":"2012","journal-title":"Osteoporos. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A scale for the quality assessment of narrative review articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cger.2010.08.009","article-title":"The frailty syndrome: Definition and natural history","volume":"27","author":"Xue","year":"2011","journal-title":"Clin. Geriatr. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e21.00065","DOI":"10.2106\/JBJS.RVW.21.00065","article-title":"Is frailty associated with adverse outcomes after orthopaedic surgery? A systematic review and assessment of definitions","volume":"9","author":"Lemos","year":"2021","journal-title":"JBJS Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/21514593231188864","article-title":"Frailty and pre-frailty in the setting of total joint arthroplasty: A narrative review","volume":"14","author":"Pearl","year":"2023","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Church, S., Rogers, E., Rockwood, K., and Theou, O. (2020). A scoping review of the Clinical Frailty Scale. BMC Geriatr., 20.","DOI":"10.1186\/s12877-020-01801-7"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1100\/tsw.2001.58","article-title":"Accumulation of deficits as a proxy measure of aging","volume":"1","author":"Mitnitski","year":"2001","journal-title":"Sci. World J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2464","DOI":"10.1111\/jgs.14387","article-title":"Comparison of frailty measures as predictors of outcomes after orthopedic surgery","volume":"64","author":"Cooper","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_17","first-page":"181","article-title":"Techniques for the diagnosis of sarcopenia","volume":"11","author":"Rubbieri","year":"2014","journal-title":"Clin. Cases Miner. Bone Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1093\/gerona\/63.8.829","article-title":"Sarcopenia \u2260 dynapenia","volume":"63","author":"Clark","year":"2008","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_19","first-page":"127","article-title":"Defining sarcopenia: Some caveats and challenges","volume":"23","author":"Marco","year":"2020","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"afac220","DOI":"10.1093\/ageing\/afac220","article-title":"Sarcopenia definition, diagnosis and treatment: Consensus is growing","volume":"51","author":"Sayer","year":"2022","journal-title":"Age Ageing"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Jimenez-Gutierrez, G.E., Mart\u00ednez-G\u00f3mez, L.E., Mart\u00ednez-Armenta, C., Pineda, C., Mart\u00ednez-Nava, G.A., and Lopez-Reyes, A. (2022). Molecular mechanisms of inflammation in sarcopenia: Diagnosis and therapeutic update. Cells, 11.","DOI":"10.3390\/cells11152359"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1055\/s-0040-1713355","article-title":"Comparative analysis on the effects of sarcopenia following primary total knee arthroplasty: A retrospective matched-control analysis","volume":"35","author":"Ardeljan","year":"2022","journal-title":"J. Knee Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.1016\/j.arth.2016.04.020","article-title":"Simplified frailty index as a predictor of adverse outcomes in total hip and knee arthroplasty","volume":"31","author":"Shin","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Chang, K., Albright, J.A., Testa, E.J., Balboni, A.B., Daniels, A.H., and Cohen, E. (2023). Sarcopenia is associated with an increased risk of postoperative complications following total hip arthroplasty for osteoarthritis. Biology, 12.","DOI":"10.3390\/biology12020295"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/S0736-0266(03)00052-4","article-title":"Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis","volume":"21","author":"Stevens","year":"2003","journal-title":"J. Orthop. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.jamda.2022.01.056","article-title":"Impact of sarcopenia and obesity on gait speed after total knee replace-ment","volume":"23","author":"Liao","year":"2022","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"afac118","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":"ref_28","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.arth.2021.08.022","article-title":"Frailty transitions one year after total joint arthroplasty: A cohort study","volume":"37","author":"Johnson","year":"2022","journal-title":"J. Arthroplast."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kappenschneider, T., Bammert, P., Maderbacher, G., Greimel, F., Parik, L., Holzapfel, D.E., Schraag, A.D., G\u00f6tz, J., Michalk, K., and Grifka, J. (2024). The impact of primary total hip and knee replacement on frailty: An observational prospective analysis. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-07210-w"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.jor.2025.04.015","article-title":"Sarcopenia in total joint Arthroplasty: Risk factor for poor postoperative outcomes and higher costs of care","volume":"69","author":"Zaronias","year":"2025","journal-title":"J. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tanaka, S., Kayamoto, A., Terai, C., Nojiri, S., Fugane, Y., Mori, T., Nagaya, M., Kako, M., Iida, H., and Osawa, Y. (2024). Preoperative sarcopenia severity and clinical outcomes after total hip arthroplasty. Nutrients, 16.","DOI":"10.3390\/nu16132085"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100030","DOI":"10.1016\/j.tjfa.2025.100030","article-title":"Frailty and associated healthcare expenditures among patients undergoing total hip and knee arthroplasty","volume":"14","author":"Ron","year":"2025","journal-title":"J. Frailty Aging"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kim, S.-Y., Cho, W.-S., Park, C.-B., and Kim, B.-G. (2025). Impact of sarcopenia and functional relationships between balance and gait after total hip arthroplasty. J. Clin. Med., 14.","DOI":"10.3390\/jcm14062036"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Pegreffi, F., Chiaramonte, R., Zeppa, S.D., Lauretani, F., Salvi, M., Zucchini, I., Veronese, N., Vecchio, M., Bartolacci, A., and Stocchi, V. (2024). Optimizing the preoperative preparation of sarcopenic older people: The role of prehabilitation and nutritional supple-mentation before knee arthroplasty. Nutrients, 16.","DOI":"10.3390\/nu16203462"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s42836-024-00294-8","article-title":"Clinical frailty scale predicts outcomes following total joint arthroplasty","volume":"7","author":"Wall","year":"2025","journal-title":"Arthroplasty"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.pmrj.2010.05.008","article-title":"Joint replacement and hip fracture readmission rates: Impact of discharge destination","volume":"2","author":"Riggs","year":"2010","journal-title":"PM&R"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1519\/JPT.0000000000000368","article-title":"The impact of sarcopenia risk on postoperative walking independence in older adults undergoing total joint arthroplasty","volume":"47","author":"Nanri","year":"2024","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Su, Y., Peng, L., Dong, D., Ma, Z., and Gu, X. (2024). Impact of sarcopenia in elderly patients undergoing elective total hip arthroplasty on postoperative outcomes: A propensity score-matched study. BMC Anesthesiol., 24.","DOI":"10.1186\/s12871-024-02538-1"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"afac288","DOI":"10.1093\/ageing\/afac288","article-title":"The impact of frailty on patient-reported outcomes following hip and knee arthroplasty","volume":"51","author":"Cook","year":"2022","journal-title":"Age Ageing"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1016\/j.arth.2021.01.033","article-title":"Frailty, race\/ethnicity, functional status, and adverse outcomes after total hip\/knee arthroplasty: A moderation analysis","volume":"36","author":"Dharmasukrit","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"292","DOI":"10.5435\/JAAOS-D-22-00642","article-title":"Frailty among total hip and knee arthroplasty recipients: Epidemiology and propensity score-weighted analysis of effect on in-hospital postoperative outcomes","volume":"31","author":"Zalikha","year":"2023","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1007\/s00402-021-04250-y","article-title":"Can extant comorbidity indices identify patients who experience poor outcomes following total joint arthroplasty?","volume":"143","author":"McConaghy","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e315","DOI":"10.3928\/01477447-20220805-04","article-title":"Phenotypic frailty score predicts perioperative outcomes for geriatric total joint arthroplasty","volume":"45","author":"Pervaiz","year":"2022","journal-title":"Orthopedics"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/SLA.0000000000002967","article-title":"Frailty as a predictor of death or new disability after surgery: A prospective cohort study","volume":"271","author":"McIsaac","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Zhang, X.-Y., Zhou, X., Han, J.-C., Wu, S., Zhang, X.-Q., Cui, Q.-T., Huang, P.-T., Cai, Y.-Y., Zhang, C., and Liu, A.-F. (2025). Impact of sarcopenia on clinical outcomes of older adults undergoing total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis. BMC Musculoskelet. Disord., 26.","DOI":"10.1186\/s12891-025-09245-z"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1589\/jpts.34.60","article-title":"Differences in preoperative function and outcome of patients with versus without sarcopenia after total hip arthroplasty","volume":"34","author":"Koto","year":"2022","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s00198-025-07731-7","article-title":"Prevalence of osteosarcopenia in patients with end-stage knee osteoarthritis who underwent total knee arthroplasty","volume":"37","author":"Heo","year":"2026","journal-title":"Osteoporos. Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3128","DOI":"10.1016\/j.arth.2024.06.021","article-title":"Prevalence and clinical impact of sarcopenia in patients undergoing total joint arthroplasty: A systematic review and a meta-analysis","volume":"39","author":"Sumbal","year":"2024","journal-title":"J. Arthroplast."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3578\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:12:53Z","timestamp":1778731973000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103578"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103578","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]}}}