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

Abstract

Introduction The aim of the study was to compare the clinical outcomes following elective and traumatic total hip arthroplasty in Parkinson's disease patients. Materials and Methods Ten patients with osteoarthritis comprise the elective group (mean age at operation 74 years; mean follow-up 82 months). Thirteen patients with femoral fracture comprise the hip fracture group (mean age 76 years; mean follow-up 54 months). All patients were followed up at 6 and 36 months postoperatively and at the time of the latest follow-up. Results Despite the significant improvement in Merle d'Aubigné-Postel and pain scores, disability related to Parkinson's disease increased during the follow-up. Whereas more than 1/3 of hip fracture patients and all elective patients walked independently at 36 months after total hip arthroplasty, 43% of living patients from both groups were able to walk independently at the time of the latest follow-up. The medical complications were seen mainly in patients with hip fracture. Conclusions Excellent pain relief with preserved walking ability without support of another person and acceptable complication profile was observed in Parkinson's disease patients at 36 months after elective total hip arthroplasty. This procedure may be indicated in Parkinson's disease patients after careful and individualized planning.

Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis

“…The majority of studies have demonstrated that THA and TKA are safe in patients with Parkinson's disease and achieve excellent pain control [16][17][18][19]. Functional outcomes are less clear, but longer term are likely related at least in part to disease progression [13,14,39].…”

“…The literature on THA and TKA outcomes in PD patients is largely limited to case series of operations performed between the 1970s and 1990s [11][12][13][14][15]. Of the larger studies that have been done, all demonstrated that PD patients experienced relief of pain, the most common reason for surgery, but changes in functional status were less consistent [16][17][18][19]. Studies of perioperative complications associated with TKA and THA have suggested that comorbid PD is associated with increased rates of perioperative urinary tract infection, cognitive dysfunction, blood transfusion, periprosthetic infection, hip fracture, or dislocation [19][20][21][22].…”

Total hip arthroplasty in Parkinson’s disease patients: a propensity score-matched analysis with minimum 2-year surveillance

“…[6][7][8][9] Meanwhile, PD patients are living longer and with progressively improving medical treatment enabling them to maintain greater functional status long-term, PD patients can be considered for both elective hip arthroplasty as well as arthroplasty as a treatment for fracture. 10 Previously, PD has been considered a contraindication to both total knee (TKA) and total hip arthroplasties (THAs). 7,11 Patients with PD have reportedly experienced higher rates of medical complications than those among the general population.…”

“…12 Early studies also demonstrated high postoperative mortality following arthroplasty in PD patients, suggesting increased dislocation rates with uncertain long-term functional gains. 7,10 However, recent studies have suggested that both hip and knee arthroplasty provide excellent long-term pain relief, with dislocation rates likely comparable to that of the general population. 1,5,7,10,[13][14][15][16] Dislocation rates after THA are reported to range between 0.2 and 2% in the general population, and anywhere from 0 to 37% in PD patients, with 1 standardised review finding no difference in outcomes from patients without PD.…”

“…7,10 However, recent studies have suggested that both hip and knee arthroplasty provide excellent long-term pain relief, with dislocation rates likely comparable to that of the general population. 1,5,7,10,[13][14][15][16] Dislocation rates after THA are reported to range between 0.2 and 2% in the general population, and anywhere from 0 to 37% in PD patients, with 1 standardised review finding no difference in outcomes from patients without PD. [4][5][6]17,18 It has also been suggested that aggressive rehabilitation and early weight-bearing after surgery decrease the dislocation rate and provide PD patients with functional improvement until around 1 year postoperatively, at which point functional decline appears to result from progression of the neuromuscular disease itself.…”