The Prognostic Value of Frailty Assessment Tools in Predicting Postoperative Outcomes After Revision Total Hip and Knee Arthroplasty: A Systematic Review

Background/Objectives: Frailty has emerged as a relevant marker of biological vulnerability in patients undergoing complex orthopedic procedures, yet its specific prognostic value in revision total hip and knee arthroplasty remains incompletely synthesized. This systematic review evaluated whether validated preoperative frailty assessment tools are associated with adverse postoperative outcomes after revision total joint arthroplasty and whether available studies allow comparison of prediction performance across instruments. Methods: A systematic search of PubMed/MEDLINE, Embase, the Cochrane Library, Web of Science, Scopus, citation lists, and selected gray-literature sources was performed from inception through January 2026. Gray-literature records and conference abstracts were used only for citation tracking; the synthesis included only full-length peer-reviewed original research articles involving adult patients undergoing revision total hip arthroplasty, revision total knee arthroplasty, or both, with quantitative outcomes according to a validated frailty measure. Because of heterogeneity in frailty tools, outcome definitions, revision indications, and adjustment strategies, findings were synthesized narratively and certainty was assessed by outcome domain. Results: Eleven full-length studies were included, with cohorts ranging from 117 patients to 576,920 admissions, and most were retrospective database analyses. Higher frailty burden was consistently associated with worse short-term outcomes, including complications, prolonged hospital stay, readmission, non-home discharge, resource use, and mortality-related risk stratification. Representative findings included 30-day readmission of 23.8% versus 9.9%, surgical complications of 28.6% versus 7.8%, and odds ratios of up to 10.79 for complications across escalating frailty strata. Prediction studies suggested stronger discrimination for revision-specific or broader models, such as CARDE-B, RAI-rev, and machine-learning approaches, than for simpler generic frailty indices. Conclusions: Frailty is a consistent preoperative marker of elevated short-term perioperative risk after revision arthroplasty. The available evidence supports incorporating frailty assessment into preoperative risk stratification and counseling, but it remains insufficient to establish one universally preferred tool or to prove that frailty screening alone improves outcomes without targeted intervention.