Total Hip Arthroplasty in Patients With Parkinson's Disease

Abstract

The aim of this study is to evaluate the results of total hip arthroplasty in patients with Parkinson's disease during a period of five years, focusing on the assessment of the risks and benefits of surgery. During this period we performed total hip arthroplasty in 14 patients (15 hips) with Parkinson's disease. Patients were evaluated by subjective symptoms and objective findings, with a focus on the use of support while walking and walking distance, severity of Parkinson's disease before surgery and at the time of the last follow-up. During the postoperative period, the following parameters were assessed: length of ICU stay, mobilization, complications, the total duration of hospitalization and follow-up care after discharge. Of the 11 patients (12 hips) followed-up 1-5 years with an average of 3 years after operation 8 cases showed progression of neurological disability. 5 patients (6 hips) showed an increased dependence on the use of support when walking and reduced distance that the patient was able to walk. Subjectively, 10 hip joints were completely painless and 2 patients complained of only occasional mild pain in the operated hip. Complications that were encountered were urinary tract infection (5 patients), cognitive impairment (3 patients) and pressure ulcer (2 patients). We did not observe any infection or dislocation of the prosthesis. Three patients fell and fractured the femur and 3 patients in our cohort died during follow up. Implantation of total replacement is possible with judicious indication after careful evaluation of neurological finding in patients with minimal or mild functional impairment of the locomotor system. Prerequisite for a good result is precise surgical technique and optimal implant position with balanced tension of the muscles and other soft tissues around the hip.

Total Hip Arthroplasty in Patients With Parkinson Disease: Improved Outcomes With Dual Mobility Implants and Cementless Fixation

“…THA in patients with PD is a challenging surgery because of associated comorbidity and complications. Previous studies reported the high general and local complication rates in these patients (2,4). Our results indicate that 11 patients with primary THA (29.7%) and 8 patients with revision THA (40.0%) had general complications, consistent with previously published works.…”

“…Previous reports of the outcome of THA in PD patients indicate that acetabular and femoral component fixation in THA can be achieved using cemented devices [2,4,6]. A recent meta-analysis concluded that PD patients were at higher risk of osteoporosis than healthy control subjects (OR 2.61) [34].…”

“…These patients were injured because of fall. Mathew et al [4] reported that the 2 patients (13.3%) of 15 PD patients had a periprosthetic fracture after THA. In PD patients, fragility fractures caused by poor bone quality and falls because of the disturbed postural reflex [35].…”

Prevalence and Perioperative Outcomes of Off-Label Total Hip and Knee Arthroplasty in the United States, 2000–2010

“…These findings are corroborated by previous reports of high rates of infections (i.e., superficial wound infections, urinary tract infections) and psychoses following surgery among THA patients with neurodegenerative disease or a history of substance abuse, respectively. 28–30 …”

“…35 Patients with Parkinson’s disease experience much higher complication rates (26% – 68%) and 6-month mortality rates (5.6% – 21%) after primary THA than those patients without Parkinson’s disease. 28,30 Mental disability has been associated with longer LOS, greater inpatient costs, and higher rates of complications. 36 Revision arthroplasty is a clinically complex endeavor often resulting in net institutional financial losses.…”