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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2026; 17(2): 115188
Published online Feb 18, 2026. doi: 10.5312/wjo.v17.i2.115188
Published online Feb 18, 2026. doi: 10.5312/wjo.v17.i2.115188
Impact of preoperative frailty on complications, readmissions, and functional recovery following total knee arthroplasty in elderly patients
Muhammad Bilal Yasin, Muhammad Raheel, Department of Trauma and Orthopaedics Surgery, Bahawal Victoria Hospital, Bahawalpur 63100, Punjab, Pakistan
Muhammad Mustafa Ahmed, Department of Orthopedics, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Worksop S81 0BD, United Kingdom
Sheharyar Ashfaq, Department of Orthopedics, Hull University Teaching Hospital NHS Trust, Cottingham HU16 5JQ, United Kingdom
Hamdoon Suharwardy Asim, Department of Orthopedics, Dartford and Gravesham NHS Trust, DA2 8DA, England, United Kingdom
Mohammed Qasim Rauf, Department of Orthopedic Surgery, Hillingdon Hospital, Uxbridge UB8 3NN, United Kingdom
Renad Fahim, Department of Trauma and Orthopedic, Jinnah Sindh Medical University, Karachi 75510, Sindh, Pakistan
Rejina Chhetri, Department of Surgery, Nepalgunj Medical College, Kohal 21900, Nepal
Co-first authors: Muhammad Bilal Yasin and Muhammad Raheel.
Author contributions: Yasin MB conceptualized the study, curated the data, performed formal analysis, acquired funding, and drafted the original manuscript; Yasin MB and Raheel M have played important and indispensable roles in the manuscript preparation as co-first authors; Raheel M contributed to data curation, investigation, and validation, while also reviewing and editing the manuscript; Ahmed MM and Ashfaq S provided methodological guidance, supervised the project, and critically revised the manuscript for intellectual content; Asim HS and Rauf MQ assisted with data acquisition, visualization, and software implementation; Fahim R supported investigation and resource management; Chhetri R oversaw administration, ensured ethical compliance, led the writing, review, and editing process; all authors approved the final version and agree to be accountable for all aspects of the work in accordance with the credit taxonomy.
Institutional review board statement: This retrospective cohort study was approved by the Institutional Review Board of Bahawal Victoria Hospital, Bahawalpur, Pakistan (No. 2025-ORTH-012). The study adhered to institutional ethical standards, the Declaration of Helsinki, and relevant national regulations for research involving de-identified medical records.
Informed consent statement: Informed consent was waived due to the retrospective nature of the study, which involved analysis of de-identified existing medical records.
Conflict-of-interest statement: The authors declare that they have no conflict of interest related to the publication of this article.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: : No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rejina Chhetri, MD, Department of Surgery, Nepalgunj Medical College, Banke Baijanath 1 Chisapani, Kohal 21900, Nepal. rejinachhetri01@gmail.com
Received: October 14, 2025
Revised: October 28, 2025
Accepted: November 26, 2025
Published online: February 18, 2026
Processing time: 117 Days and 7 Hours
Revised: October 28, 2025
Accepted: November 26, 2025
Published online: February 18, 2026
Processing time: 117 Days and 7 Hours
Core Tip
Core Tip: This retrospective cohort study from Pakistan demonstrates that preoperative frailty, assessed by the modified Frailty Index, significantly increases postoperative complications, hospital length of stay, and 90-day readmissions while impairing 1-year functional recovery in elderly patients undergoing total knee arthroplasty. Findings are most applicable to tertiary referral centers in Pakistan. Routine frailty screening could enhance risk stratification and perioperative management in resource-limited settings, addressing challenges like high tuberculosis prevalence to optimize outcomes and reduce healthcare burdens. A practical pathway includes: (1) The modified Frailty Index ≥ 0.27 to flag high-risk; (2) Initiate low-cost prehabilitation (nutritional screening/supplementation, home-based resistance exercises, medication review); and (3) Multidisciplinary review before surgery.