The Arthroplasty Risk Tool (ART Score) was developed through a comprehensive review of the arthroplasty literature to identify modifiable preoperative factors consistently associated with postoperative complications such as periprosthetic joint infection (PJI), wound complications, and readmission. Eight variables were selected for their reproducible associations with outcomes, clinical availability, and modifiability:
Fructosamine (glycemic control)
Hemoglobin
Total lymphocyte count (TLC)
Transferrin
Prealbumin
Body mass index (BMI)
Vitamin D
Smoking status
For each variable, odds ratios (ORs) were extracted from large-scale studies, meta-analyses, or registry-based cohorts. Where multiple ORs were available, we prioritized those derived from higher-quality or TJA-specific analyses. Odds ratios were transformed using the natural logarithm (ln[OR]) to allow proportional weighting across variables. These weights were then normalized to a cumulative 100-point scale, ensuring that each variable contributed to the overall risk score in proportion to its effect size.
Risk categories were defined as:
Low: 0–29.9
Moderate: 30–49.9
High: 50–69.9
Very High: ≥70
This framework integrates laboratory and clinical data into a single score, providing surgeons and patients with a transparent, evidence-based approach to preoperative optimization and shared decision-making. The ART Score is designed for clinical use, not to replace judgment or institutional guidelines, but to provide objective context when counseling patients or responding to payer-imposed thresholds. A prospective multicenter validation study is in development.