Total hip replacement in patients with Parkinson's disease

Abstract

From 1970 to 1994, 107 total hip arthroplasties (THAs) were performed in 98 patients with Parkinson's disease. The average age of the patients was 72 years. Preoperative diagnoses were osteoarthrosis in 58 hips, failed endoprosthesis in 19, aseptic loosening in ten, femoral neck fracture in 18, and other diagnoses in two. Milder neurological stages I-III were assigned to 96 patients, and tendon release for contracture was performed in eight patients. Of the 38 complications eight were urinary tract infections and six dislocations. Of these 15 occurred in the 58 primary THAs and 23 in the 49 nonprimary THAs. In patients with primary THAs there were no dislocations; however, one of the four postoperative deaths occurred following primary THA. We followed 75 hips for 7 (2-21) years; 51 patients had died by the time of the study. Neurological status deteriorated over time with 57% of patients progressing to functional stages IV or V, although consistent improvement was noted for pain relief. Function was directly related to the stage of the neurological disease.Résumé De 1970 à 1994, 107 arthroplasties totales de la hanche (THA) ont été exécutées chez 98 patients atteints de la maladie de Parkinson. L'âge moyen des patients était 72 ans. Le diagnostic préopératoires étaient une coxarthrose pour 58 hanches, un échec de prothèse pour 29, une fracture du col fémoral pour 18, et une autres cause pour 2. 96 patients avaient un état neurologique correspondant à un stade I à III. Des ténotomies pour contractures ont été faite chez huit patients. Il y avait 38 complications parmi lesquelles huit infections urinaires et six luxations. 15 des complications se sont produites dans les 58 arthroplasties primaires et 23 dans les 49 non-primaires. Dans le groupe des arthroplasties primaires il y avait un des quatre morts postopératoires mais aucune luxation. 75 hanches ont été suivies pendant 7 (2-21) années. 51 patients étaient décédés au moment de l'étude. L'état neurologique s'est altéré avec le temps avec 57% des patients atteignant les stades IV ou V. Une amélioration constante a été notée dans le soulagement de la douleur. La fonction était en rapport direct avec le stade de la maladie neurologique.

Shoulder arthroplasty in patients with Parkinson's disease is associated with increased complications

“…16,21,26 Poor functional results after lower extremity arthroplasty in patients with PD have been attributed to preexisting muscle rigidity, severe tremor, dystonia, postural instability, and motor disturbances leading to increased falls. These patients also have a postoperative mortality rate 1.6-times to 3-times higher than that of the general population.…”

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.…”

The Outcomes of Total Hip Replacement in Patients with Parkinson’s Disease: Comparison of the Elective and Hip Fracture Groups

“…Contemporary total hip arthroplasty is one of the highly efficient surgical techniques leading to improvement in the patient's quality of life [ 7 ]. Nonetheless, reports of the outcomes of elective total hip arthroplasty in patients with Parkinson's disease in the literature are sparse [ 8 , 9 ]. But it is reasonable to be aware that orthopaedic surgeons will increasingly be required to evaluate the suitability of patients with Parkinson's disease for total hip arthroplasty.…”