Supplementary file 1_Frailty across Hip arthroplasty pathways: vulnerability domains, outcomes, and implications for care—a narrative review.docx

Physical frailty and sarcopenia are more closely related to functional recovery, whereas multidimensional assessment can identify interacting and potentially actionable vulnerabilities. Nutritional-inflammatory indices may add modest mortality-prediction information in hip-fracture surgery, but they partly reflect acute illness and remain adjunct markers rather than validated core frailty domains. Evidence is stronger for prognostic association than for the effectiveness of frailty-guided interventions.</p>Conclusions<p>A clinically useful pathway should combine low-burden screening with targeted vulnerability-domain assessment, incorporate procedure context, and repeat assessment during recovery.

Frailty should guide proportional monitoring, rehabilitation, discharge planning, and shared decisions rather than serve as an isolated threshold for denying surgery. Research priorities include context-specific validation, standardized patient-centred and resource outcomes, longitudinal assessment, and trials of domain-informed care.</p>