Publication Name	World Journal of Orthopedics
Manuscript ID	115188
Country	Nepal

Category	Orthopedics
Manuscript Type	Retrospective Cohort Study
Article Title	Impact of preoperative frailty on complications, readmissions, and functional recovery following total knee arthroplasty in elderly patients
Manuscript Source	Unsolicited Manuscript
All Author List	Muhammad Bilal Yasin, Muhammad Raheel, Muhammad Mustafa Ahmed, Sheharyar Ashfaq, Hamdoon Suharwardy Asim, Mohammed Qasim Rauf, Renad Fahim and Rejina Chhetri
Funding Agency and Grant Number
Corresponding Author	Rejina Chhetri, MD, Department of Surgery, Nepalgunj Medical College, Banke Baijanath 1 Chisapani, Kohal 21900, Nepal. rejinachhetri01@gmail.com
Key Words	Total knee arthroplasty; Frailty; Modified Frailty Index; Postoperative complications; Elderly; Pakistan; Knee Society Score; Hospital length of stay; Readmission; Functional recovery
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.
Citation	Yasin MB, Raheel M, Ahmed MM, Ashfaq S, Asim HS, Rauf MQ, Fahim R, Chhetri R. Impact of preoperative frailty on complications, readmissions, and functional recovery following total knee arthroplasty in elderly patients. World J Orthop 2025; In press

Received	2025-10-14 01:49
Peer-Review Started	2025-10-14 01:49
To Make the First Decision
Return for Revision	2025-10-27 09:25
Revised	2025-10-28 18:32
Second Decision	2025-11-26 02:37
Accepted by Journal Editor-in-Chief
Accepted by Executive Editor-in-Chief	2025-11-26 09:43
Articles in Press	2025-11-26 09:43
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ISSN	2218-5836 (online)
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