Randomized Controlled Trial

. 2025 Apr;14(2):100028.

doi: 10.1016/j.tjfa.2025.100028. Epub 2025 Mar 4.

Getting fit for hip and knee replacement: The Fit-Joints multimodal intervention for frail patients with osteoarthritis - a pilot randomized controlled trial

Chinenye Okpara¹, Ahmed Negm², Jonathan Derrick Adachi³, David Armstrong³, Stephanie Atkinson⁴, Victoria Avram⁵, Justin de Beer⁵, Genevieve Hladysh⁶, George Ioannidis⁷, Courtney Kennedy⁸, Patricia Hewston⁹, Arthur Lau³, Justin Lee⁸, Julie Richardson¹⁰, Sharon Marr⁸, Akbar Panju³, Danielle Petruccelli⁵, Lehana Thabane¹¹, Mitchell Winemaker⁵, Alexandra Papaioannou¹²

Affiliations

¹ Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
² Faculty of Rehabilitation Science, University of Alberta, Edmonton, AB, Canada.
³ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁴ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁵ Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada.
⁶ The YMCA of Hamilton/Burlington/Brantford, Hamilton, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
⁷ Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
⁸ Department of Medicine, McMaster University, Hamilton, ON, Canada; Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
¹⁰ School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
¹¹ Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joseph's Healthcare, Hamilton, ON, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.
¹² Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joseph's Healthcare, Hamilton, ON, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa. Electronic address: papaioannou@hhsc.ca.

PMID: 40042971
PMCID: PMC12184060
DOI: 10.1016/j.tjfa.2025.100028

Randomized Controlled Trial

Getting fit for hip and knee replacement: The Fit-Joints multimodal intervention for frail patients with osteoarthritis - a pilot randomized controlled trial

Chinenye Okpara et al. J Frailty Aging. 2025 Apr.

. 2025 Apr;14(2):100028.

doi: 10.1016/j.tjfa.2025.100028. Epub 2025 Mar 4.

Authors

Affiliations

¹ Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
² Faculty of Rehabilitation Science, University of Alberta, Edmonton, AB, Canada.
³ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁴ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁵ Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada.
⁶ The YMCA of Hamilton/Burlington/Brantford, Hamilton, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
⁷ Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
⁸ Department of Medicine, McMaster University, Hamilton, ON, Canada; Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
¹⁰ School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
¹¹ Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joseph's Healthcare, Hamilton, ON, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.
¹² Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joseph's Healthcare, Hamilton, ON, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa. Electronic address: papaioannou@hhsc.ca.

PMID: 40042971
PMCID: PMC12184060
DOI: 10.1016/j.tjfa.2025.100028

Abstract

Background: Older adults with frailty have high risk for poor postoperative outcomes.

Objective: To evaluate the feasibility of a multimodal prehabilitation program in older adults with frailty awaiting hip or knee replacement.

Design: Parallel two-arm randomized controlled pilot trial.

Participants and setting: Community-dwelling older adults with frailty awaiting joint replacement aged ≥60 years recruited from the Musculoskeletal Central Intake and Assessment Centre (MSK CIAC), Ontario.

Intervention: Exercise, protein and vitamin D supplements, and medication review.

Measurement: Feasibility was assessed based on predefined progression criteria for recruitment, retention, data completion and adherence to intervention components. Clinical outcomes including Oxford Knee and Hip Scores, frailty index, Short Physical Performance Battery and health-related quality of life were collected at baseline, 1-week preoperative, 6-weeks and 6-months postoperative and were evaluated using generalized linear mixed models for repeated measures.

Results: A total of 69 participants were enrolled. Recruitment rate was 35 %. Participants' mean age was 74 (standard deviation (SD): 7.5); 51 % were prefrail and 36 % were frail. Participant retention was 81 %, and data completion was ≥80 %. Mean adherence to strength exercises was 4 days (95 % confidence interval (CI): 3-5 days/week), balance 3 days (95 % CI: 2-4 days/week), and flexibility 3 days (95 % CI: 3-4 days/week). Adherence to vitamin D intake was 82 % (95 % CI: 73-92 %), and medication review consultation completion was 86 % (95 % CI: 68-95 %). These outcomes met the target values for feasibility success. The Oxford Knee Score at 6-months postoperative 8.78 (95 % CI: 0.40-17.16) showed a clinically meaningful and statistically significant difference between treatment groups. There were also indications of clinically relevant changes for frailty and quality of life post-surgery.

Conclusion: This trial provides strong evidence of feasibility and indications of improvements in postoperative clinical outcomes. Challenges to implementation and adherence were identified that can inform modifications to study design for future trials.

Trial registration: ClinicalTrials.gov NCT02885337. Registered August 31, 2016. https://classic.

Clinicaltrials: gov/ct2/show/NCT02885337.

Keywords: Frailty; Joint replacement; Older adults; Osteoarthritis; Rehabilitation.

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Conflict of interest statement

Competing interests DA reports research funding: Weston Foundation and Nestlé Health Sciences; consulting: Cinclus Pharma and Phathom Pharma; speaker honorarium: Fresenius Kabi and Takeda Canada, Amgen; industry: Co-founder A.I. VALI; not-for-profit: Board member, Canadian Digestive Health Foundation, Treasurer and Board member, International Working Group for the Classification of Oesophagitis. JL reports personal fees from Research Institute of St. Joe's, grants from Canadian Institutes of Health Research (CIHR), and grants from United States Deprescribing Network (USDeN), outside the submitted work. SM reports grants from Daniels Foundation, grants from CIHR, personal fees from Unity Health Toronto, and other from Unity Health Toronto, Providence Health Care, during the conduct of the study. All other authors (CO, AN, JDA, SAA, VA, JDB, GH, GI, CK, PH, AL, JR, AP, DP, LT, MW, AP) declare that they have no competing interests.

Figures

Fig 1: — **Fig 1**
CONSORT flow chart of participants.

See this image and copyright information in PMC

References

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Getting fit for hip and knee replacement: The Fit-Joints multimodal intervention for frail patients with osteoarthritis - a pilot randomized controlled trial

Affiliations

Getting fit for hip and knee replacement: The Fit-Joints multimodal intervention for frail patients with osteoarthritis - a pilot randomized controlled trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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MeSH terms

Substances

Associated data

LinkOut - more resources

Full Text Sources

Medical

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