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Huebschmann NA, Lawrence KW, Robin JX, Rozell JC, Hepinstall MS, Schwarzkopf R, Aggarwal VK. Does Surgical Approach Affect Dislocation Rate After Total Hip Arthroplasty in Patients Who Have Prior Lumbar Spinal Fusion? A Retrospective Analysis of 16,223 Cases. J Arthroplasty 2024:S0883-5403(24)00312-7. [PMID: 38604275 DOI: 10.1016/j.arth.2024.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Lumbar spinal fusion (LSF) is a risk factor for dislocation following total hip arthroplasty (THA). The effect of the surgical approach on this association has not been investigated. This study examined the association between the surgical approach and dislocation following THA in patients who had prior LSF. METHODS We retrospectively reviewed 16,223 primary elective THAs at our institution from June 2011 to September 2022. Patients who had LSF prior to THA were identified using International Classification of Diseases (ICD) codes. Patients were stratified by LSF history, surgical approach, and intraoperative robot or navigation use to compare dislocation rates. There were 8,962 (55.2%) posterior, 5,971 (36.8%) anterior, and 1,290 (8.0%) laterally based THAs. Prior LSF was identified in 323 patients (2.0%). Binary logistic regressions were used to assess the association of patient factors with dislocation risk. RESULTS There were 177 dislocations identified in total (1.1%). In nonadjusted analyses, the dislocation rate was significantly higher following the posterior approach among all patients (P = .003). Prior LSF was associated with a significantly higher dislocation rate in all patients (P < .001) and within the posterior (P < .001), but not the anterior approach (P = .514) subgroups. Multivariate regressions demonstrated anterior (OR [odds ratio] = 0.64, 95% CI [confidence interval] 0.45 to 0.91, P = .013), and laterally based (OR = 0.42, 95% CI 0.18 to 0.96, P = .039) approaches were associated with decreased dislocation risk, whereas prior LSF (OR = 4.28, 95% CI 2.38 to 7.69, P < .001) was associated with increased dislocation risk. Intraoperative technology utilization was not significantly associated with dislocation in the multivariate regressions (OR = 0.72, 95% CI 0.49 to 1.06, P = .095). CONCLUSIONS The current study confirmed that LSF is a significant risk factor for dislocation following THA; however, anterior and laterally based approaches may mitigate dislocation risk in this population. In multivariate analyses, including surgical approach, LSF, and several perioperative variables, intraoperative technology utilization was not found to be significantly associated with dislocation risk.
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Affiliation(s)
- Nathan A Huebschmann
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Joseph X Robin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
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Wang J, Zhao Z, Liang H, Niu J, Liu X, Wang H, Yang Y, Yan T, Guo W, Tang X. Clinical outcomes in patients with neurological disorders following periacetabular tumor removal and endoprosthetic reconstruction of the hemipelvis. Front Surg 2024; 11:1279179. [PMID: 38505408 PMCID: PMC10948498 DOI: 10.3389/fsurg.2024.1279179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Background Surgical treatment of musculoskeletal tumors in the periacetabular region present extremely difficult due to the complex anatomy and need for reconstruction. Orthopedic surgeons face more difficulties in patients with neurological conditions, which can cause increased muscle tone, an elevated risk of fractures, and compromised bone quality. There is limited evidence regarding endoprosthetic reconstruction for periacetabular tumors in individuals with neurological disorders. Methods We conducted a single-center retrospective study to examine the outcomes of patients with preexisting neurological conditions who underwent surgery to remove periacetabular tumors and who underwent endoprosthesis reconstruction. Clinical presentation, detailed neurological conditions, complications, and functional outcomes were studied. Results Sixteen out of the 838 patients were identified (1.91%), with a mean follow-up time of 33 months. The primary neurological conditions encompassed Parkinson's disease, Alzheimer's disease, dementia, and cerebral ischemic stroke. Every patient was diagnosed with periacetabular lesions that were either primary or oligometastatic. They underwent tumor resection and subsequently received endoprosthetic reconstruction of the hemipelvis. Three patients developed metastasis lesions later, and two patients experienced tumor recurrence. Five cases experienced hip dislocation-one with periprosthetic fracture and one with surgical site infection. The position of the prosthetic rotating center was not correlated with dislocation. The reoperation rate was 31.25%. The cohort of patients all presented with more extended hospital stays and rehabilitation. In 3 patients, the general functional score was good, while in 6 patients, it was fair; in 7 patients, it was regarded as poor. The average MSTS93 score was 49.71%. Conclusion Endoprosthetic reconstruction after periacetabular tumor resection is an effective way to eliminate tumors and salvage limbs. However, this group of patients has an increased likelihood of secondary surgery, complications, extended hospital stay, and no significant improvement in functional outcomes. Despite the diverse nature of the cohort, it is recommended to consider enhanced soft tissue reconstruction, supervised functional recovery and rehabilitation training.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xiaodong Tang
- The Musculoskeletal Tumor Center, Peking University People’s Hospital, Xicheng District, Beijing, China
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Dham B, Richard I, Schneider EB, George BP. Association of Postoperative Delirium and Parkinson Disease After Common United States Surgical Procedures. J Surg Res 2023; 291:711-719. [PMID: 37566934 DOI: 10.1016/j.jss.2023.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION To determine the association of Parkinson disease (PD) and postoperative delirium following common surgical procedures. METHODS We performed a retrospective database analysis of the National Inpatient Sample. We used a matched sample of patients with and without PD who underwent any of ten common surgical procedures in the US, 2005-2014. Primary outcome measure was postoperative delirium for patients with and without PD. Secondary measures included disposition, length of stay, and hospital costs. RESULTS There were 3,235,866 patients receiving any of the ten most common operative procedures, 2005-2014. There were 35,743 patients with and without PD matched based on age, sex, elective admission status, Charlson Comorbidity index, and presence of dementia. Median age was 77 y (interquartile range 72-82), median Charlson Comorbidity index was 1 (standard deviation 0-2), 46.6% were female, and 46.8% were admitted electively. The three most common operative procedures were hip arthroplasty (28.5%), knee arthroplasty (16.1%), and percutaneous coronary angioplasty (14.9%). Postoperative delirium was present in 1519 patients with PD compared to 828 matched patients without PD (4.2% versus 2.3%; P < 0.001). The adjusted odds ratio of postoperative delirium for PD compared to the matched cohort without PD was 1.88 (95% confidence interval 1.73-2.05). Those undergoing spinal fusion (adjusted odds ratio 2.99, 95% confidence interval 2.06-4.38) had the greatest odds of delirium. For patients with PD, adjusted length of stay, adjusted hospital costs, and adjusted odds of postacute care facility discharge were greater compared to the matched cohort without PD. CONCLUSIONS Patients with PD are more likely to develop postoperative delirium and have a more complicated postoperative course with longer length of stay and greater hospitalization costs.
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Affiliation(s)
- Bhavpreet Dham
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Irene Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Eric B Schneider
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin P George
- Department of Neurology, University of Rochester Medical Center, Rochester, New York.
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Zhao Z, Wang J, Guo Y, Niu J, Guo W, Yang R, Yan T, Tang X. The outcomes of proximal femur replacement with hemiarthroplasty after tumor resection in individuals with Parkinson's disease. Front Surg 2023; 10:1279813. [PMID: 37901304 PMCID: PMC10611458 DOI: 10.3389/fsurg.2023.1279813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Background Patients with neurological disorders often experience a high incidence of postoperative complications following proximal femur replacement (PFR) surgery. The orthopaedist faces a significant difficulty in treating Parkinson's disease (PD) because of the weakened bone condition, excessive muscle tension, and increased risk of fractures. The objective of this research is to assess the impact of PD on PFR following tumor removal. Methods A retrospective study was conducted from 2010 to 2020, focusing on a solitary institution, analyzing 9 patients diagnosed with PD who underwent PFR with hemiarthroplasty as a result of tumor removal. The study consists of 2 men and 7 women, with an average age of 71 (SD, 12) years. We assessed the outcomes after surgery in terms of pain management, quality of life, functional ability, occurrence of complications, and survival durations. Results All nine patients underwent planned surgeries. Intraoperative complications was not observed. The average length of the follow-up period was 24 (SD, 20) months, ranging from 8 to 72 months. Despite the fact that 8 patients passed away due to tumor progression, the endoprostheses were still well at that point. The preoperative VAS score of 7 (SD, 1.87) decreased to a postoperative score of 2 (SD, 1.32). The KPS was improved to73 (SD, 7) from 52 (SD, 14), postoperatively. Post-surgery, there were notable enhancements in both pain levels and the overall quality of life scores. Following the surgical procedure, individuals are able to ambulate steadily, resuming their regular daily routines. Living patients had an average MSTS score of 21 (SD, 2.5), ranging from 17 to 25. In total, there were four (44.4%) patients suffered complications after surgery, comprising of one wound dehiscence, one prosthetic fracture, one hip dislocation, and one local recurrence. Conclusions Significant improvements in function and pain relief can be achieved through PFR with hemiarthroplasty following tumor removal in patients with PD. The implementation of thorough preparation and carefull nursing results in reduced complications and improved outcomes in PD patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
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Berreta RS, Zhang H, Alsoof D, Khatri S, Casey J, McDonald CL, Diebo BG, Kuris EO, Basques BA, Daniels AH. Adult Spinal Deformity Correction in Patients with Parkinson Disease: Assessment of Surgical Complications, Reoperation, and Cost. World Neurosurg 2023; 178:e331-e338. [PMID: 37480985 DOI: 10.1016/j.wneu.2023.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Parkinson disease (PD) is a neurodegenerative disorder that manifests with postural instability and gait imbalance. Correction of spinal deformity in patients with PD presents unique challenges. METHODS The PearlDiver database was queried between 2010 and 2020 to identify adult patients with spinal deformity before undergoing deformity correction with posterior spinal fusion. Two cohorts were created representing patients with and without a preoperative diagnosis of PD. Outcome measures included reoperation rates, surgical technique, cost, surgical complications, and medical complications. Multivariable logistic regression adjusting for Charlson Comorbidity Index, age, gender, 3-column osteotomy, pelvic fixation, and number of levels fused was used to assess rates of reoperation and complications. RESULTS In total, 26,984 patients met the inclusion criteria and were retained for analysis. Of these patients, 725 had a diagnosis of PD before deformity correction. Patients with PD underwent higher rates of pelvic fixation (odds ratio [OR], 1.33; P < 0.001) and 3-column osteotomies (OR, 1.53; P < 0.001). On adjusted regression, patients with PD showed increased rates of reoperation at 1 year (OR, 1.37; P < 0.001), 5 years (OR, 1.32; P < 0.001), and overall (OR, 1.33; P < 0.001). Patients with PD also experienced an increased rate of medical complications within 30 days after deformity correction including deep venous thrombosis (OR, 1.60; P = 0.021), pneumonia (OR, 1.44; P = 0.039), and urinary tract infections (OR, 1.54; P < 0.001). Deformity correction in patients with PD was associated with higher 90-day cost (P = 0.007). CONCLUSIONS Patients with PD undergoing long fusion for deformity correction are at significantly increased risk of 30-day medical complications and revision procedures after 1 year, controlling for comorbidities, age, and invasiveness. Surgeons should consider the risk of complications, subsequent revision procedures, and increased cost.
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Affiliation(s)
| | - Helen Zhang
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Surya Khatri
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jack Casey
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Eren O Kuris
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Bryce A Basques
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
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Wang Y, Wang S, Yang X. Prevalence of different types of wound infection in subjects with Parkinson's disease and total joint arthroplasty: A meta-Analysis. Int Wound J 2023; 20:2780-2787. [PMID: 36924416 PMCID: PMC10410355 DOI: 10.1111/iwj.14154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
A meta-analysis study to assess the influence of Parkinson's disease (PD) on different types of wound infection (WI) in total joint arthroplasty (TJA) patients. A comprehensive literature examination till January 2023 was implemented and 1976 linked studies were appraised. The picked studies contained 76 661 subjects with TJA in the picked studies' baseline, 19 188 of them were PD, and 57 473 were non-PD. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of PD on different types of WI in TJA patients by the dichotomous and continuous styles and a fixed or random model. PD had a significantly higher postoperative surgical site WI (OR, 1.76; 95% CI, 1.15-2.67, P = .009), superficial WI (OR, 3.36; 95% CI, 1.41-7.99, P = .006), and periprosthetic WI (OR, 4.89; 95% CI, 2.13-11.22, P < .001) compared to the non-PD in TJA patients' post-surgery wounds. PD had a significantly higher postoperative surgical site WI, superficial WI, and periprosthetic WI compared to the non-PD in TJA patients' post-surgery wounds. Though precautions should be taken when commerce with the consequences since some of the picked studies for this meta-analysis was with low sample sizes.
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Affiliation(s)
- Yidong Wang
- Department of Geriatric MedicineWenzhou Central HospitalZhejiangChina
| | - Shuangshuang Wang
- Department of Wound Medicinethe Second Affiliated Hospital of Wenzhou Medical UniversityZhejiangChina
| | - Xiao Yang
- Department of Intensive Medicinethe First Affiliated Hospital of Kunming Medical UniversityYunnanChina
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O’Driscoll CS, Hughes AJ, Davey MS, Queally JM, O’Daly BJ. Total Hip Arthroplasty in Patients With Neurological Conditions: A Systematic Review. Arthroplast Today 2022; 19:101068. [PMID: 36568851 PMCID: PMC9768244 DOI: 10.1016/j.artd.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background As operative techniques and implant design have evolved over time, total hip arthroplasty (THA) is increasingly being carried out for patients with neurological impairment. This patient group places unique surgical challenges to the arthroplasty surgeon, which may include contractures, instability, and altered muscular tone. The purpose of this systematic review is to report the patient outcomes, complications, and implant survival following THA for patients with neurological conditions affecting the hip. Thus, we aim to support orthopaedic surgeon decision-making when considering and planning THA for these patients. Methods A systematic review was performed as per Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed/Medline OVID, Cochrane, and Embase databases. All studies reporting the outcomes of THA in the neurological population which met defined inclusion criteria were included. Results From an initial screen of 1820 studies, 45 studies with a total of 36,251 THAs were included in the final selection. All 45 studies reported complication rates, with controls included in 16 for comparison. High complication rates were observed following THA in the neurologically impaired population, most notably dislocation with observed rates up to 10.6%. An improvement was noted in all 36 studies (1811 THAs) which reported upon patient-reported outcomes. Conclusions THA may be beneficial in the selected patients with neurological conditions, to reduce pain and improve function. There is an increased risk of complications which require careful consideration when planning the operation and open discussion with prospective patients and caregivers before proceeding with surgery.
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Affiliation(s)
- Conor S. O’Driscoll
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Corresponding author. Tallaght University Hospital, Dublin, Ireland. Tel.: +353857884714.
| | - Andrew J. Hughes
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Rothman Orthopedic Institute, Thomas Jefferson University Hospital, PA, USA
| | - Martin S. Davey
- Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Joseph M. Queally
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, St James Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - Brendan J. O’Daly
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
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Logli AL, Rizzo M. Operative Treatment of Distal Radius Fractures in Patients With Parkinson Disease. Hand (N Y) 2022; 17:37S-42S. [PMID: 34218706 PMCID: PMC9793611 DOI: 10.1177/15589447211028931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Owing to the many unique disease characteristics of Parkinson disease (PD)-namely resting tremors, muscular rigidity, and poor bone quality-we hypothesized that this patient population would have inferior outcomes with surgical management of acute distal radius fractures (DRFs) compared with the literature available on the general population. METHODS This is a retrospective observational study performed at a single, level 1, academic center from 2001 to 2020 capturing all adult patients with an isolated, acute, and closed DRF that ultimately underwent operative treatment. International Classification of Diseases 10 codes were used to identify 30 patients for manual chart review. Several patient and fracture characteristics were accounted for and complications, reoperations, and failures of surgical intervention were recorded. RESULTS There was a total of 7/30 failures (23%), 6/30 reoperations (20%), and 12 complications in 9/30 wrists (complication rate, 30%) at a mean latest follow-up of 11 months (1.2-158 months). Of the 7 failures, 5 were due to loss of reduction, and 2 of them were deep infections with mean time to failure of 8.3 weeks (range, 11 days-5.2 months). CONCLUSIONS This study found a high rate of complications, reoperations, and early failure despite a short follow-up period and a small cohort of patients with PD treated surgically for a DRF. We recommend locked plating if suitable for the fracture type and early involvement of a multidisciplinary team to assist with medical optimization of PD to increase chances of a successful outcome.
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Gillinov SM, Joo PY, Zhu JR, Moran J, Rubin LE, Grauer JN. Incidence, Timing, and Predictors of Hip Dislocation After Primary Total Hip Arthroplasty for Osteoarthritis. J Am Acad Orthop Surg 2022; 30:1047-1053. [PMID: 35947825 PMCID: PMC9588560 DOI: 10.5435/jaaos-d-22-00150] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/11/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) may be complicated by dislocation. The incidence of and risk factors for dislocation are incompletely understood. This study aimed to determine the incidence and predictors of hip dislocation within 2 years of primary THA. METHODS The 2010 to 2020 PearlDiver MHip database was used to identify patients undergoing primary THA for osteoarthritis with a minimum of 2 years of postoperative data. Dislocation was identified by associated codes. Age, sex, body mass index, Elixhauser Comorbidity Index, fixation method, and bearing surface were compared for patients with dislocation versus control subjects by multivariate regression. Timing and cumulative incidence of dislocation were assessed. RESULTS Among 155,185 primary THAs, dislocation occurred within 2 years in 3,630 (2.3%). By multivariate analysis, dislocation was associated with younger age (<65 years), female sex, body mass index < 20, higher Elixhauser Comorbidity Index, cemented prosthesis, and use of metal-on-poly or metal-on-metal implants ( P< 0.05 for each). Among patients who experienced at least one dislocation, 52% of first-time dislocations occurred in the first 3 months; 57% had more than one and 11% experienced >5 postoperative dislocation events. Revision surgery was done within 2 years of index THA for 45.6% of those experiencing dislocation versus 1.8% of those who did not ( P < 0.001). CONCLUSION This study found that 2.3% of a large cohort of primary THA patients experienced dislocation within 2 years, identified risk factors for dislocation, and demonstrated that most patients experiencing dislocation had recurrent episodes of instability and were more likely to require revision surgery.
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Affiliation(s)
- Stephen M Gillinov
- From the Yale School of Medicine, New Haven, CT (Gillinov, Joo, Zhu, and Moran); Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Rubin and Grauer)
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Beckert M, Meneghini RM, Meding JB. Instability After Primary Total Hip Arthroplasty: Dual Mobility Versus Jumbo Femoral Heads. J Arthroplasty 2022; 37:S571-S576. [PMID: 35271976 DOI: 10.1016/j.arth.2022.02.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of dual mobility (DM) articulations has grown substantially over the last decade to help minimize dislocation risk. The purpose of this study is to compare the results of DM articulations to jumbo femoral heads of equivalent sizes as they relate to postoperative dislocation. METHODS This is a retrospective cohort study of primary total hip arthroplasties (THAs) performed at a single institution between 2005 and 2018. DM articulations and large-diameter metal-on-metal femoral heads were included. Patients were followed with Harris Hip Scores and standard radiographs. Complications were prospectively recorded. Statistical analyses included chi-squared and Brown-Forsythe tests. RESULTS In total, 1,288 Magnum femoral head THAs and 365 Active Articulation DM THAs were included for analysis. The same monoblock cup was implanted via a posterior approach in all cases. Age, gender, body mass index, and diagnosis were similar between groups. Average follow-up in the DM group was 49 months, and 126 months in the jumbo head group. The average head sizes in the DM and jumbo head groups were 50 mm. There were no dislocations in the DM hips and only 2 (0.2%) in the jumbo femoral head group. Both groups had significant improvements in Harris Hip Score from their preoperative baseline. CONCLUSION Our study found similarly low dislocation rates in DM and jumbo femoral heads in primary THA. No evidence currently exists showing a benefit of the DM articulation beyond that of the large effective head size, and we recommend making every attempt at maximizing head size prior to using DM articulations.
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Affiliation(s)
- Mitchell Beckert
- The Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; The IU Hip and Knee Center, Fishers, IN
| | - R Michael Meneghini
- The Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; The IU Hip and Knee Center, Fishers, IN
| | - John B Meding
- The Center for Hip and Knee Surgery, St. Francis Hospital Mooresville, Mooresville, IN
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Hogg E, Frank S, Oft J, Benway B, Rashid MH, Lahiri S. Urinary Tract Infection in Parkinson’s Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:743-757. [PMID: 35147552 PMCID: PMC9108555 DOI: 10.3233/jpd-213103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Urinary tract infection (UTI) is a common precipitant of acute neurological deterioration in patients with Parkinson’s disease (PD) and a leading cause of delirium, functional decline, falls, and hospitalization. Various clinical features of PD including autonomic dysfunction and altered urodynamics, frailty and cognitive impairment, and the need for bladder catheterization contribute to an increased risk of UTI. Sepsis due to UTI is a feared consequence of untreated or undertreated UTI and a leading cause of morbidity in PD. Emerging research suggests that immune-mediated brain injury may underlie the pathogenesis of UTI-induced deterioration of PD symptoms. Existing strategies to prevent UTI in patients with PD include use of topical estrogen, prophylactic supplements, antibiotic bladder irrigation, clean catheterization techniques, and prophylactic oral antibiotics, while bacterial interference and vaccines/immunostimulants directed against common UTI pathogens are potentially emerging strategies that are currently under investigation. Future research is needed to mitigate the deleterious effects of UTI in PD.
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Affiliation(s)
- Elliot Hogg
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel Frank
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jillian Oft
- Department of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brian Benway
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Shouri Lahiri
- Departments of Neurology, Neurosurgery, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Evaluation of the rate of post-operative dislocation in patients with ipsilateral valgus knee deformity after primary total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:1507-1514. [DOI: 10.1007/s00264-022-05372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
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Awadallah M, Blanco J, Ong J, Kumar N, Rajata P, Parker M. Is there a higher risk of dislocation of hip hemiarthroplasty in patients with neuromuscular conditions? A clinical study of 3827 patients. Injury 2022; 53:631-633. [PMID: 34789388 DOI: 10.1016/j.injury.2021.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 02/02/2023]
Abstract
AIM OF THE STUDY The aim of this study is to identify if there is any association between neuromuscular disorders and prosthetic dislocation in patients treated with hip hemiarthroplasty for neck of femur fractures. PATIENTS AND METHODS Our study is a retrospective analysis of data collected over 34 years for patients with intracapsular neck of femur fracture who underwent hip hemiarthroplasty. Pathological fractures and patients treated with other treatment modalities were excluded. The study population is composed of four groups; patients with no neuromuscular disorders, patients with Parkinson's disease, patients with previous stroke, and patients with mental impairment. RESULTS A total of 3827 patients were treated with hip hemiarthroplasty. For the 3371 patients with no neuromuscular condition (Group I) the dislocation rate was 1.1%. 219 patients had Parkinsonism (Group II) with a dislocation rate of 3.2%, 104 patients had a previous stroke with weakness on the fracture side with a dislocation rate of 1.0% (Group III), and 984 patients had severe mental impairment with a dislocation rate of 1.8% (Group IV). The increased dislocation rate for those with Parkinson's disease was statistically significant (p = 0.02) while none of the other neuromuscular conditions were statistically significant. CONCLUSION Our study demonstrates an increased risk of dislocation after hemiarthroplasty for patients with Parkinson's disease in comparison to other groups. No increase was apparent for those with mental impairment or weakness from a previous stroke.
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Affiliation(s)
- Mahmoud Awadallah
- Peterborough City Hospital, Department of Orthopaedics, North West Anglia NHS Foundation Trust, Bretton Gate, Peterborough PE3 9GZ, United Kingdom.
| | - Jose Blanco
- Peterborough City Hospital, Department of Orthopaedics, North West Anglia NHS Foundation Trust, Bretton Gate, Peterborough PE3 9GZ, United Kingdom
| | - Joshua Ong
- Peterborough City Hospital, Department of Orthopaedics, North West Anglia NHS Foundation Trust, Bretton Gate, Peterborough PE3 9GZ, United Kingdom
| | - Niroshan Kumar
- Peterborough City Hospital, Department of Orthopaedics, North West Anglia NHS Foundation Trust, Bretton Gate, Peterborough PE3 9GZ, United Kingdom
| | - Pushparaj Rajata
- Peterborough City Hospital, Department of Orthopaedics, North West Anglia NHS Foundation Trust, Bretton Gate, Peterborough PE3 9GZ, United Kingdom
| | - Martyn Parker
- Peterborough City Hospital, Department of Orthopaedics, North West Anglia NHS Foundation Trust, Bretton Gate, Peterborough PE3 9GZ, United Kingdom
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14
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Marchand KB, Vakharia R, Sodhi N, Anis H, Salem HS, Scuderi GR, Mont MA, Roche MW. Impact of Parkinson's Disease on Complications, Readmission Rates, and Costs of Care following Primary Total Knee Arthroplasty. J Knee Surg 2022; 35:21-25. [PMID: 32462645 DOI: 10.1055/s-0040-1710546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Large-scale studies evaluating the effects of Parkinson's disease (PD) on primary total knee arthroplasty (TKA) are limited. The purpose of this study was to determine if PD patients undergoing primary TKA have increased: (1) medical complications; (2) implant-related complications; (3) readmission rates; and (4) costs. A query was performed using an administrative claims database. The study group consisted of all patients undergoing primary TKA who had a history of PD. Matched non-PD patients undergoing primary TKA served as a control group. The query yielded 72,326 patients (PD = 18,082; matching cohort = 54,244). Pearson's chi-square tests, logistic regression analyses, and Welch's t-tests were used to test for significance between the cohorts. Primary TKA patients who had PD were found to have greater incidences and odds of medical complications (4.21 vs. 1.24%; odds ratio [OR]: 3.50, 95% confidence interval [CI]: 3.15-3.89, p < 0.0001) and implant-related complications (5.09 vs. 3.15%; OR: 1.64, 95% CI: 1.51-1.79, p < 0.0001) compared with the matching cohort. Additionally, the rates and odds of 90-day readmission were higher (16.29 vs. 12.66%; OR:1.34, p < 0.0001) and episodes of care costs were significantly greater ($17,105.43 vs. $15,252.34, p < 0.0001) in patients who had PD. Results demonstrate that PD patients undergoing primary TKA had higher incidences of medical and implant-related complications. They also had increased 90-day readmission rates and costs compared with controls. The findings of this study should be used in risk stratification and should inform physician-patient discussion but should not be arbitrarily used to deny access to care.
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Affiliation(s)
- Kevin B Marchand
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, New York
| | - Rushabh Vakharia
- Department of Orthopedic Surgery, Holy Cross Hospital, Trinity Health, Fort Lauderdale, Florida
| | - Nipun Sodhi
- Northwell Health Orthopedics, Long Island Jewish Medical Center, New York, New York
| | - Hiba Anis
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Hytham S Salem
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, New York
| | - Giles R Scuderi
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, New York
| | - Michael A Mont
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, New York
| | - Martin William Roche
- Department of Orthopedic Surgery, Holy Cross Hospital, Trinity Health, Fort Lauderdale, Florida
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15
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Price CC. The New Frontier of Perioperative Cognitive Medicine for Alzheimer's Disease and Related Dementias. Neurotherapeutics 2022; 19:132-142. [PMID: 35084722 PMCID: PMC9130373 DOI: 10.1007/s13311-021-01180-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 01/03/2023] Open
Abstract
This is a review of preoperative cognitive assessment and other healthcare gaps in the care of older adults at risk for Alzheimer's disease and related dementias (ADRD) who have elected surgery with anesthesia. It summarizes concerns regarding ADRD perioperative healthcare, perioperative cognitive, and neuronal domains of vulnerability. It also offers a plan for phased preoperative cognitive screening and perioperative cognitive intervention opportunities. An argument is made for why medical professionals in the perioperative setting need fundamental training in cognitive-behavioral principles, an understanding of neurodegenerative diseases of aging, and an appreciation of the immediate and long-term medical risks for such patients undergoing anesthesia. The author's goal is to encourage readers to consider perioperative cognitive medicine as a new frontier for generating evidence-based care approaches for at-risk older adults with neurodegenerative disorders who require procedures with anesthesia.
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Affiliation(s)
- Catherine C Price
- Clinical and Health Psychology, Anesthesiology, University of Florida, Gainesville, FL, USA.
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16
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Pirruccio K, Premkumar A, Sheth NP. The burden of prosthetic hip dislocations in the United States is projected to significantly increase by 2035. Hip Int 2021; 31:714-721. [PMID: 32390488 DOI: 10.1177/1120700020923619] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Prosthetic hip dislocation is a common, costly complication of total hip arthroplasty (THA). Despite this, the national burden of prosthetic hip dislocations remains uncharacterised in the United States, especially pertaining to injuries occurring years after the index procedure. This study examines historical and projected national estimates of prosthetic hip dislocations presenting to U.S. emergency departments between 2000 and 2035. METHODS We conducted a cross-sectional, retrospective epidemiological study using narratives in the National Electronic Injury Surveillance System (NEISS) database (2000-2017) to identify an estimated 64,671 prosthetic hip implant dislocations presenting to U.S. emergency departments. Estimates for the prevalence of individuals living with a total hip implant were derived from the literature. RESULTS The national estimate of prosthetic hip dislocations presenting to U.S. emergency departments rose significantly (p < 0.001) between 2000 (n = 2395; 95% CI, 1264-3526) and 2017 (n = 8094; 95% CI, 4276-11,912). These increases are likely driven by increased numbers of people living with THA overall, since between 2000 and 2017, the average incidence of prosthetic hip dislocation (0.14%; CI 0.08-0.21%) in patients living with hip implants has not changed significantly. Linear regression modeling (R2 = 0.7, p < 0.01) projected an increasing number of dislocations through 2035, predicting 10,446 national cases per year by this date. CONCLUSIONS Driven by increases in THA, the annual volume of prosthetic hip dislocations presenting to U.S. emergency departments has increased significantly since 2000 and is projected to continue to rise sharply. Future advances in surgical technique, prosthesis design, and injury prevention policies aimed at decreasing the rate of THA dislocation would help alleviate this mounting national health burden.
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Affiliation(s)
- Kevin Pirruccio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Neil P Sheth
- Department of Orthopaedic Surgery University of Pennsylvania, Philadelphia, PA, USA
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17
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Tueth LE, Duncan RP. Musculoskeletal pain in Parkinson's disease: a narrative review. Neurodegener Dis Manag 2021; 11:373-385. [PMID: 34410146 PMCID: PMC8515213 DOI: 10.2217/nmt-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022] Open
Abstract
The prevalence of musculoskeletal (MSK) pain in people with Parkinson's disease (PD) is higher than that of age-matched controls. In this review, we outline what is known about MSK pain in PD, focusing on the neck, shoulder, knee, hip and low back. We also compare what is known about MSK pain in PD to what is known in older adults without PD. Finally, we outline areas of for future research related to MSK pain in people with PD.
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Affiliation(s)
- Lauren Elizabeth Tueth
- Program in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Ryan P Duncan
- Program in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO 63108, USA
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63108, USA
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18
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Goh GS, Zeng GJ, Tay DK, Lo NN, Yeo SJ, Liow MHL. Patients With Parkinson's Disease Have Poorer Function and More Flexion Contractures After Total Knee Arthroplasty. J Arthroplasty 2021; 36:2325-2330. [PMID: 33277144 DOI: 10.1016/j.arth.2020.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/24/2020] [Accepted: 11/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) may negatively influence the rehabilitative course after total knee arthroplasty (TKA). However, functional outcomes in this select group remain poorly defined. We compared complication, mortality and revision rates, as well as patient-reported outcomes, and satisfaction between patients with PD and controls after TKA. METHODS Patients with PD who underwent primary unilateral TKA were identified and matched 1:1 with a control group using propensity scores adjusting for age, sex, body mass index, Charlson Comorbidity Index, baseline range of motion, Knee Society Knee Score, Knee Society Function Score, Oxford Knee Score, and 36-item Short-Form Health Survey Mental and Physical Component Summary. Functional outcomes and patient satisfaction were assessed at 6 months and 2 years. Complications, survivorship, and all-cause mortality were analyzed. RESULTS In total, 114 patients were included. Majority of PD patients had Hoehn and Yahr stage 1 or 2 disease. Overall complication rate was 26.3% in the PD group and 10.5% in the control group (P = .030). There was no difference in transfusions, length of stay, and discharge to rehabilitation or readmissions. Patients with PD had more flexion contractures, poorer Knee Society Function Score and Oxford Knee Score at 2 years, and poorer 36-item Short-Form Health Survey Physical Component Summary at 6 months. 80.4% of patients with PD were satisfied compared with 85.5% of controls (P = .476). At follow-up of 8.5 ± 2.7 years, one TKA was revised in each group. All-cause mortality was higher in the PD group (15.8% vs 5.3%, P = .067). CONCLUSION Although patients with PD had relatively poorer knee function and quality of life, these patients still experienced significant functional gains compared with their preoperative status, and high satisfaction was achieved. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Gerald J Zeng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Darren K Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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19
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McCormack D, Boksh K, Sheikh N. Total hip arthroplasty in Parkinson's disease - A systematic review of the current evidence. J Orthop 2021; 24:284-290. [PMID: 33897131 DOI: 10.1016/j.jor.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/25/2021] [Indexed: 01/21/2023] Open
Abstract
This systematic review assessed the efficacy, survivorship, and complications of Total Hip Replacement (THR) in Parkinson's Disease (PD). Databases were searched according to the Preferred Reporting Items for Systematic Reviews. PD patients had higher wound infections, dislocations, peri-prosthetic fractures, and revision surgery compared to their non-PD counterparts. They also had inferior functional outcomes, and longer and expensive hospital admissions. Dual-mobility (DM) implants had the lowest survival rate. THR in PD patients is associated with significant surgical complications and peri-operative challenges. Despite the use of DM implants to minimize instability, there is insufficient evidence on its effectiveness and long-term survivorship.
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Affiliation(s)
- Daniel McCormack
- Department of Trauma and Orthopaedics, Kettering General Hospital, Kettering, United Kingdom
| | - Khalis Boksh
- Department of Trauma and Orthopaedics, Kettering General Hospital, Kettering, United Kingdom
| | - Nomaan Sheikh
- Department of Trauma and Orthopaedics, Kettering General Hospital, Kettering, United Kingdom
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20
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Montiel Terrón V, Vitoria M, Lamo de Espinosa Vázquez de Sola JM, Valentí Nin JR, Valentí Azcárate A. Do we really improve life quality after total knee arthroplasty in patients with Parkinson's disease? Arch Orthop Trauma Surg 2021; 141:313-319. [PMID: 33165682 DOI: 10.1007/s00402-020-03644-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The knee in Parkinson's disease (PD) patients is a problematic joint due to pain, stiffness and gait instability. The aim of this study is to evaluate the functional outcome and degree of pain relief achieved after total knee arthroplasty (TKA) in PD patients. MATERIALS AND METHODS This is a retrospective review of 26 PD patients (32 knees) with osteoarthritis who underwent a TKA between 1994 and 2013. Comorbidities, anesthetic procedures and complications were recorded. Patient functional status was assessed with the Knee Society Function Score (KFS) and the Knee Society Score (KSS). PD stage was classified with the Hoehn and Yahr Scale. RESULTS The mean follow-up was 3.5 years (range 2-9). The mean age was 71 years (range 61-83) with a mean time since PD diagnosis of 11.8 years (range 4-24). PD severity on the Hoehn and Yahr Scale was 1.5 points before surgery and 2 points postoperatively. Pain on the visual analogic scale improved from 8 points preoperatively to 5 points at 1-year follow-up; function improved from 32 (range 20-45) to 71 (range 50-81) and from 34 (range 28-52) to 59 (range 25-76) on the KSS and KFS, respectively. The mean postoperative hospital stay was 9.8 days (range 5-21). Confusion and flexion contracture were the most frequent perioperative complications. CONCLUSION TKA successfully provided pain relief in PD patients. However, the functional outcome is related to disease progression and, therefore, variable. Perioperative complications are difficult to avoid and manage.
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Affiliation(s)
- Verónica Montiel Terrón
- Orthopedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008, Pamplona, Spain.
| | - María Vitoria
- Orthopedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008, Pamplona, Spain
| | | | - Juan Ramón Valentí Nin
- Orthopedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008, Pamplona, Spain
| | - Andrés Valentí Azcárate
- Orthopedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008, Pamplona, Spain
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21
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Baek JH, Nam CH, Lee SC, Ahn HS, Ha YC. Poor outcomes of primary total knee arthroplasty in patients with Parkinson's disease. INTERNATIONAL ORTHOPAEDICS 2021; 45:643-647. [PMID: 33403438 DOI: 10.1007/s00264-020-04924-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to compare the functional outcomes, activity levels, mortalities, implant survival rates, and complications of total knee arthroplasty (TKA) of patients with Parkinson's disease (PD) with those of patients in a control group over a minimum ten year follow-up period. METHODS From January 2007 to December 2009, 46 TKAs were performed in 29 patients with PD (PD group). Fifty-eight matched patients without PD were used as the control group in a two-to-one ratio using propensity scoring matching. The functional outcomes, activity levels, mortalities, implant survival rates, and complications of TKA in patients with PD and control group were compared. RESULTS The mean Knee Society knee scores in PD and control group improved from 36.8 and 37.1 pre-operatively to 60.0 and 80.7 points at the final follow-up, respectively (p < 0.05). Outdoor ambulatory patients at the final follow-up included 13 of 20 (65.0 %) in PD group and 51 of 54 (94.4%) patients in control group (p < 0.05). The cumulative mortality rates in PD and control group were 31% (9/29) and 6.9% (4/58) (p < 0.05), at final follow-up, respectively. Kaplan-Meier survivorship analysis with revision of either components as endpoints in PD and control group estimated 89.7% and 98.3% chances of survival for ten years, respectively. CONCLUSIONS TKAs in patients with PD were shown to have worse functional outcomes and higher mortality over a minimum ten year follow-up period. Therefore, the necessity of the procedure should be considered carefully depending on patient needs and conditions.
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Affiliation(s)
- Ji-Hoon Baek
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
| | - Chang Hyun Nam
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
| | - Su Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
| | - Hye Sun Ahn
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 06973, Republic of Korea.
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22
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Fontalis A, Kenanidis E, Bennett-Brown K, Tsiridis E. Clinical outcomes in elective total hip arthroplasty in Parkinson's disease: a systematic review of the literature. EFORT Open Rev 2020; 5:856-865. [PMID: 33425374 PMCID: PMC7784138 DOI: 10.1302/2058-5241.5.200034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Parkinson’s disease (PD) poses a significant challenge for the arthroplasty surgeon, owing to excessive muscle tone, higher fracture risk and poor bone quality. Several studies have reported high mortality, early failure and perioperative complications associated with hip fracture surgery in PD; however, no higher-level evidence exists regarding elective hip arthroplasty. The aim of our study was to perform a systematic review to evaluate the evidence basis and clinical outcomes pertaining to patients with underlying Parkinson’s disease undergoing elective total hip arthroplasty (THA). We searched MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials to identify studies evaluating the safety and clinical outcomes of THA in patients suffering from Parkinson’s. Our review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ten studies encompassing 49,730 patients were included in our systematic review. Qualitative synthesis demonstrated comparable results between PD patients and controls with respect to one-year mortality and surgical site infections. PD patients experienced more medical complications, had a longer hospital stay and worse long-term implant survival. Some studies also reported a higher rate of dislocation, periprosthetic fractures and aseptic loosening. Decisions about the optimal articulation, the utilization of cemented components, dual-mobility cups or constrained liners were not uniform among included studies. THA in patients with Parkinson’s disease can offer significant functional gains and pain relief. Surgical considerations pertain to the approach and ways to address instability, whereas emphasis should be placed on appropriate counselling and exploring whether potential improvement of life quality outweighs the risks.
Cite this article: EFORT Open Rev 2020;5:856-865. DOI: 10.1302/2058-5241.5.200034
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Affiliation(s)
- Andreas Fontalis
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, UK.,Academic Unit of Bone Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Eustathios Kenanidis
- Academic Orthopaedic Unit, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Eleftherios Tsiridis
- Academic Orthopaedic Unit, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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23
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Shah NV, Solow M, Lavian JD, Bloom LR, Grieco PW, Stroud SG, Abraham R, Naziri Q, Paulino CB, Maheshwari AV, Diebo BG. Total hip arthroplasty in Parkinson's disease patients: a propensity score-matched analysis with minimum 2-year surveillance. Hip Int 2020; 30:684-689. [PMID: 31269822 DOI: 10.1177/1120700019862247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) patients experience chronic pain related to osteoarthritis at comparable rates to the general population. While total hip arthroplasty (THA) effectively improves pain, functionality, and quality of life in PD patients, long-term outcomes following THA are under-reported. This study sought to investigate whether PD patients have an increased risk of complications and revision following THA in comparison to the general population. METHODS Utilising New York State's Statewide Planning and Research Cooperative System, all PD patients who underwent THA from 2009 to 2011 with minimum 2-year follow-up were identified. A control group (no-PD) was created via 1:1 propensity score-matching by age, gender, and Charlson/Deyo score. Univariate analysis compared demographics, complications, and revisions. Multivariate binary stepwise logistic regression identified independent predictors of outcomes. RESULTS 470 propensity score-matched patients (PD: n = 235; no-PD: n = 235) were identified. PD patients demonstrated higher rates of overall and postoperative wound infection (p < 0.05), with comparable individual and overall complication and revision rates. PD did not increase odds of complications or revisions. PD patients had lengthier hospital stay (4.97 vs. 4.07 days, p = 0.001) and higher proportion of second primary THA >2-years postoperatively (69.4% vs. 59.6%, p = 0.027). Charlson/Deyo index was the greatest predictor of any surgical complication (OR = 1.17, p = 0.029). Female sex was the strongest predictor of any medical complication (OR = 2.21, p < 0.001). DISCUSSION Despite lengthier hospital stays and infection-related complications, PD patients experienced comparable complication and revision rates to patients from the general population undergoing THA.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
| | | | - Joshua D Lavian
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
| | - Lee R Bloom
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
| | - Preston W Grieco
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
| | - Sarah G Stroud
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
| | - Roby Abraham
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, NY, USA
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24
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A Systematic Review of Total Knee Arthroplasty in Neurologic Conditions: Survivorship, Complications, and Surgical Considerations. J Arthroplasty 2020; 35:3383-3392. [PMID: 32873450 DOI: 10.1016/j.arth.2020.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations. METHODS We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke, and cerebral palsy were included. RESULTS In total 38 studies were included: 22 studies (461 patients) reported patient-reported outcome measures and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurologic conditions. Of studies reporting survivorship, mean follow-up ranged from 1 to 12 years with survivorship from 66% to 100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exist. CONCLUSION TKA in patients with neurologic disorders improves symptoms and function but carries significant risk. This review helps surgeons preoperatively counsel their patients in an informed manner. Careful planning, perioperative care, and appropriate implant selection may mitigate risk of complication.
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25
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Goh GS, Zeng GJ, Thever Y, Foong WS, Tay DKJ, Lo NN, Yeo SJ, Liow MHL. Unicompartmental knee arthroplasty in patients with Parkinson's disease. Knee 2020; 27:1325-1331. [PMID: 33010744 DOI: 10.1016/j.knee.2020.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Parkinson's disease (PD) adversely affects physical function after joint replacement. The biomechanical advantages of unicompartmental knee arthroplasty (UKA) may be particularly beneficial for these patients who suffer from gait and kinetic abnormalities. We aimed to describe the functional outcomes, complications and survivorship after UKA in patients with PD. METHODS Ten patients (11 knees) undergoing primary fixed-bearing UKA for medial osteoarthritis were studied. Knee Society Knee (KSKS) and Function Scores (KSFS), as well as the Short-Form-36 (SF-36) Mental (MCS) and Physical Component Scores (PCS) were assessed preoperatively, at six months and at two years postoperatively. Complications, survivorship and all-cause mortality were analyzed. RESULTS No perioperative complications occurred. Length of stay was 5 ± 2 days and no patients were discharged to rehabilitation or readmitted. Nine of 11 knees had a flexion contracture preoperatively and this remained unchanged at two years. KSKS and SF-36 PCS improved significantly. However, there was no improvement in KSFS or SF-36 MCS. All patients achieved minimal clinically important difference for KSKS, six of 11 for KSFS and nine of 11 for SF-36 PCS. At mean 10 ± 5 years, there was one revision for progression of osteoarthritis. Seven of 10 patients progressed in Hoehn and Yahr stage and only three were able to ambulate independently at last follow-up. CONCLUSIONS Patients suffering from osteoarthritis and PD can experience a substantial improvement in knee pain with low morbidity after UKA. However, the improved kinematics of UKA did not translate to an improved range of motion or knee function postoperatively.
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Affiliation(s)
- Graham S Goh
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
| | | | - Yogen Thever
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Wei Sheng Foong
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | | | - Ngai-Nung Lo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
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Fullard M, Thibault D, Zisling H, Crispo JA, Willis A. Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis. JOURNAL OF PARKINSONS DISEASE 2020; 10:1577-1586. [PMID: 32597816 PMCID: PMC7683077 DOI: 10.3233/jpd-201992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Advances in the treatment of Parkinson’s disease (PD) have allowed for improvements in mortality and quality survival, making the management of comorbid conditions of aging, such as osteoarthritis, crucial. Objective: To determine the extent to which PD impacts hospitalization outcomes after an elective orthopedic procedure. Methods: This retrospective cohort study used data from the National Readmissions Database and included adults ages 40 and above with and without PD. Primary outcomes included length of stay of the index admission, discharge disposition and 30-day readmission. Logistic regression was used to compare the odds of readmission for PD patients compared to non-PD. Clinical conditions associated with readmission were compared between the two groups. Results: A total of 4,781 subjects with PD and 947,475 subjects without PD met inclusion criteria. Length of stay (LOS) during the index admission was longer for PD patients. PD patients were much more likely to be discharged to inpatient post-acute care (49.3% vs 26.2%) while non-PD subjects were more likely to be discharged home with (31.9% [PD] vs 44.8% [non-PD]) or without home health (18.7% [PD] vs 28.9% [non-PD]). A total of 271 PD patients (5.66%) and 28,079 non-PD patients (2.96%) were readmitted within 30 days following surgery. After adjusting for age, sex, socioeconomic status, expected payer, comorbidities, index admission LOS, year and discharge disposition, PD subjects were 31% more likely to be readmitted than non-PD subjects (AOR 1.31, 1.07–1.62). Conclusions: Parkinson’s disease patients were readmitted more often than non-PD patients, although the rate of readmission was still low.
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Affiliation(s)
- Michelle Fullard
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Dylan Thibault
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - James A Crispo
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,University of Delaware, Newark, DE, USA
| | - Allison Willis
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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27
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Rong X, Dahal S, Luo ZY, Zhou K, Yao SY, Zhou ZK. Functional outcomes after total joint arthroplasty are related to the severity of Parkinson's disease: a mid-term follow-up. J Orthop Surg Res 2019; 14:396. [PMID: 31779661 PMCID: PMC6883575 DOI: 10.1186/s13018-019-1447-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/31/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Performing total joint arthroplasty (TJA) in Parkinson's disease (PD) patients may encounter a higher complication rate or worse functional outcomes compared with common patients. The relationship between PD and clinical outcomes after TJA is not fully understood. METHODS Retrospectively, we used manual charts to investigate the clinical outcomes in 41 patients including 24 total hip arthroplasty (THA) patients (28 hips) and 18 total knee arthroplasty (TKA) patients (22 knees) with a diagnosis of PD from 2009 to 2016. The stage of PD was confirmed by Hoehn and Yahr scale. Prosthesis survivorship was estimated with revision for any reason as the endpoint. RESULT All the clinical outcomes improved significantly (p < 0.05). Subgroup analysis revealed worse functional outcomes in mid- or end-stage PD patients. Sixteen short-term mild to moderate complications were noted. Two revisions were conducted for hip periprosthetic osteolysis and postoperative knee pain. The prosthesis survivorship at 60 months for TJA, total hip arthroplasty (THA), or total knee arthroplasty (TKA) was 91.6%, 94.1%, and 87.5%, respectively. CONCLUSION Patients with PD who underwent TJA would result in excellent pain relief and gain of function. However, patients at late-stage PD may suffer from functional loss. The effectiveness of TJA in patients with severe PD remains a concern. Physician should help delay the progression of PD which may optimize and stabilize the functional outcomes of TJA.
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Affiliation(s)
- Xiao Rong
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Suraj Dahal
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ze-Yu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Kai Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Shun-Yu Yao
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zong-Ke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
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Abstract
This article summarizes existing literature examining orthopedic interventions for patients with Parkinson disease (PD). It reviews complications and functional outcomes of shoulder, spine, knee, and hip surgeries in PD. Causes of fall-related fractures in PD and the risk of postoperative cognitive decline after orthopedic interventions in PD are also briefly discussed.
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Affiliation(s)
- Marian Livingston Dale
- Department of Neurology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code: OP32, Portland, OR 97239, USA.
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Min H, Lin H, Chen G. Effect of Parkinson's disease on primary total joint arthroplasty outcomes: A meta-analysis of matched control studies. Int J Surg 2019; 71:124-131. [PMID: 31563522 DOI: 10.1016/j.ijsu.2019.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Currently, no meta-analysis exists elucidate the outcomes of total joint arthroplasty (TJA) in patients with Parkinson's disease (PD). The aim of this study was to investigate the outcomes of TJA in patients with PD with respect to complication and revision in comparison to a TJA cohort without PD. METHODS MEDLINE, Scopus, EMBASE, and Cochrane Library databases were searched with English language restrictions. The primary outcome measures were complications and revision, whereas the secondary outcomes included length of stay (LOS) and total charge. RESULTS Seven studies with a total of 124163 patients were included. The most important finding from our study was that PD patients had a 42% higher risk for any medical complication (P = 0.004) and a 65% higher risk for any surgical complication (P = 0.01) compared to the matched cohort. Specifically, PD was associated with increased superficial wound infection (P = 0.006), dislocation (P = 0.01), deep vein thrombosis (DVT) (P = 0.02), LOS (P = 0.0005), and total hospital charges (P < 0.00001). However, PD did not increase the risks for periprosthetic infection (P = 0.32) and revision (P = 0.17). CONCLUSIONS Patients with PD are at increased risk for medical complication and surgery complications, particularly superficial wound infection, dislocation, and DVT as compared to patients without PD. PD patients also exhibit increased LOS and total hospital charges. However, PD did not increase the risks for periprosthetic infection and revision.
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Affiliation(s)
- Huan Min
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, 92 Aiguo Road, Nanchang, 330006, Jiangxi, China
| | - Hui Lin
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Gang Chen
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, 92 Aiguo Road, Nanchang, 330006, Jiangxi, China.
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Reducing Risk in Total Joint Arthroplasty: Assessing Mental Health, Mood, and Movement Disorders. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen DQ, Quinlan ND, Strotman PK, Werner BC, Browne JA. Normal Pressure Hydrocephalus Is Associated With Increased Risks of Postoperative Complications Following Total Knee and Total Hip Arthroplasty. J Arthroplasty 2019; 34:1914-1917. [PMID: 31126773 DOI: 10.1016/j.arth.2019.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/30/2019] [Accepted: 04/16/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Normal pressure hydrocephalus (NPH) has not been studied as a potential risk factor for postoperative complications after primary total knee (TKA) and total hip arthroplasty (THA). METHODS Nearly 2000 patients with a diagnosis of NPH who underwent TKA or THA from 2005 to 2014 were identified in a national insurance database and compared to 10:1 matched controls using a logistic regression analysis. RESULTS NPH was associated with an increased risk of hospital readmission, emergency room visit, and infection following TKA (odds ratio 1.48-2.70, all P < .01). NPH was associated with an increased risk of hospital readmission, emergency room visit, and dislocation following THA (odds ratio 2.40-2.50, all P < .01). NPH was also associated with significantly higher costs and hospital length of stay following both procedures. CONCLUSION The diagnosis of NPH is associated with an elevated risk of postoperative complications and increased resource utilization following TKA and THA.
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Affiliation(s)
- Dennis Q Chen
- Department of Orthopaedic Surgery, UVA Health System, Charlottesville, VA
| | - Nicole D Quinlan
- Department of Orthopaedic Surgery, UVA Health System, Charlottesville, VA
| | - Patrick K Strotman
- Department of Orthopaedic Surgery, UVA Health System, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, UVA Health System, Charlottesville, VA
| | - James A Browne
- Department of Orthopaedic Surgery, UVA Health System, Charlottesville, VA
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Kleiner JE, Gil JA, Eltorai AEM, Rubin LE, Daniels AH. Matched cohort analysis of peri-operative outcomes following total knee arthroplasty in patients with and without Parkinson's disease. Knee 2019; 26:876-880. [PMID: 31171425 DOI: 10.1016/j.knee.2019.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 04/28/2019] [Accepted: 05/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased complication rate has been reported in Parkinson's disease (PD) patients following total knee arthroplasty (TKA). However, this has not previously been studied on a national scale. The purpose of this study was to determine whether PD patients had increased cost, complication, mortality, and length of stay following TKA using a national database. METHODS The HCUP Nationwide Inpatient Sample was evaluated for the years 2000 to 2012. PD patients were matched 1:10 with non-PD control patients for age, sex, Charlson Comorbidity Index (CCI), and year of admission utilizing a propensity score matching procedure. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. RESULTS Before matching, TKA patients with PD were significantly older (p < 0.0001), more frequently male (p < 0.0001), and had a greater CCI (p = 0.3058). In the matched cohort, PD was associated with significantly increased length of stay (3.92 vs 3.71 days, p < 0.0001) and total hospital charges ($41,523.52 vs $40,657.00, p = 0.0037). There was no significant difference in in-hospital complication rate (8.28% vs 8.04%, p = 0.4297) or in-hospital mortality (0.164% vs 0.150%, p = 0.8465) between PD patients and matched non-PD patients. CONCLUSIONS Matched cohort analysis demonstrated statistically significant but clinically minor increases in length and cost of hospitalization for TKA in PD patients. Complication rate and in-hospital mortality rate was not higher in PD patients, suggesting that this group may be safely considered for TKA. LEVEL OF EVIDENCE Prognostic - Level III.
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Affiliation(s)
- Justin E Kleiner
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States of America
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States of America
| | - Adam E M Eltorai
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States of America
| | - Lee E Rubin
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Yale University, New Haven, CT, United States of America
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States of America.
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Kleiner JE, Eltorai AEM, Rubin LE, Daniels AH. Matched Cohort Analysis of Total Hip Arthroplasty in Patients With and Without Parkinson's Disease: Complications, Mortality, Length of Stay, and Hospital Charges. J Arthroplasty 2019; 34:S228-S231. [PMID: 30982760 DOI: 10.1016/j.arth.2019.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Increased complication rate has been reported in Parkinson's disease (PD) patients following total hip arthroplasty (THA). However, this has not previously been studied on a national scale. The purpose of this study was to determine whether PD patients had increased cost, complication, mortality, and length of stay following THA using a national database. METHODS The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was evaluated for the years 2000-2014. PD patients were matched 1:3 with non-PD control patients for age, gender, Charlson Comorbidity Index, and year of admission using a propensity score matching procedure. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. RESULTS 794,689 THAs were performed from 2000-2014. 4003 patients (0.50%) had comorbid Parkinson's disease. Before matching, arthroplasty patients with PD were significantly older (P < .001), more frequently male (P < .001), and had greater Charlson Comorbidity Index (P < .001). In the matched cohort, PD was associated with increased length of stay (3.1 vs 2.7 days, P < .001), total hospital charges ($49,061 vs $45,571, P < .001), and in-hospital complication rate (14.6% vs 11.7%, P < .001). There was no difference in-hospital mortality (0.50% vs 0.47%, P = .781). CONCLUSIONS Matched cohort analysis demonstrated increases in complication rate, length, and cost of hospitalization for THA in patients with PD. However, in-hospital mortality rate in PD patients was not increased. Of note, the elevation in per-episode cost ($3490) may be of concern when considering PD patients for surgery within the evolving "bundled payment" model of care. LEVEL OF EVIDENCE Prognostic- Level III.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/mortality
- Cohort Studies
- Databases, Factual
- Female
- Health Care Costs
- Hospital Charges
- Hospital Mortality
- Hospitalization
- Humans
- Inpatients
- Length of Stay
- Logistic Models
- Male
- Middle Aged
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/mortality
- Osteoarthritis, Hip/surgery
- Parkinson Disease/complications
- Parkinson Disease/mortality
- Parkinson Disease/surgery
- Patient Safety
- Postoperative Complications/etiology
- Propensity Score
- Retrospective Studies
- United States
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Affiliation(s)
- Justin E Kleiner
- Department of Orthopaedic Surgery, Brown University, Providence, RI
| | - Adam E M Eltorai
- Department of Orthopaedic Surgery, Brown University, Providence, RI
| | - Lee E Rubin
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Yale University, New Haven, CT
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University, Providence, RI
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Parkinson's disease increases the risk of perioperative complications after total knee arthroplasty: a nationwide database study. Knee Surg Sports Traumatol Arthrosc 2019; 27:2189-2195. [PMID: 29785449 DOI: 10.1007/s00167-018-4970-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/27/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Therefore, the purpose of this study was to evaluate the short-term perioperative outcomes of PD patients who underwent total knee arthroplasty (TKA). We specifically evaluated: (1) perioperative surgical and medical complications; (2) lengths of stay (LOS); and (3) total hospital charges. METHODS The Nationwide Inpatient Sample was used to identify PD patients who underwent TKA between 2002 and 2013. To control for potential confounders, PD TKA and non-PD TKA patients were propensity score matched (1:3) based on age, sex, ethnicity, Charlson Comorbidity Index, and insurance type. A total of 31,979 PD and 95,596 non-PD TKA patients were included. RESULTS PD patients had a 44% higher risk of suffering from any complication (OR 1.44; 95% CI 1.35-1.54), a 45% increased risk for any medical complication (OR 1.45; 95% CI 1.36-1.55), and a 9% higher risk for any surgical complication (OR 1.09; 95% CI 0.84-1.41). Compared to the matched cohort, PD patients had a mean LOS that was 6.5% longer (95% CI 5.46-7.54) and mean total hospital charges that were 3.05% higher (95% CI 1.99-4.11). CONCLUSIONS PD patients are more likely to have postoperative complications, longer LOS, and higher costs after TKA than non-PD TKA patients. Since many of these complications can be prevented, a team-based multi-specialty patient optimization is needed. LEVEL OF EVIDENCE Level III, therapeutic study.
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Is Parkinson's Disease Associated with Increased Mortality, Poorer Outcomes Scores, and Revision Risk After THA? Findings from the Swedish Hip Arthroplasty Register. Clin Orthop Relat Res 2019; 477:1347-1355. [PMID: 31136433 PMCID: PMC6554142 DOI: 10.1097/corr.0000000000000679] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neurological conditions such as Parkinson's disease are commonly accepted as a risk factor for an increased likelihood of undergoing revision surgery or death after THA. However, the available evidence for an association between Parkinson's disease and serious complications or poorer patient-reported outcomes after THA is limited and contradictory. QUESTIONS/PURPOSES (1) Do patients with a preoperative diagnosis of Parkinson's disease have an increased risk of death after elective THA compared with a matched control group of patients? (2) After matching for patient- and surgery-related factors, do revision rates differ between the patients with Parkinson's disease and the matched control group? (3) Are there any differences in patient-reported outcome measures for patients with Parkinson's disease compared with the matched control group? METHODS Data were derived from a merged database with information from the Swedish Hip Arthroplasty Register and administrative health databases. We identified all patients with Parkinson's disease who underwent THA for primary osteoarthritis between January 1, 1999 and December 31, 2012 (n = 490 after exclusion criteria applied). A control group was generated through exact one-to-one matching for age, sex, Charlson comorbidity index, surgical approach, and fixation method. Risk of death and revision were compared between the groups using Kaplan-Meier and log-rank testing. Patient-reported outcome measures (PROMs), routinely recorded as EQ-5D, EQ VAS, and pain VAS, were measured at the preoperative visit and at 1-year postoperatively; mean absolute values for PROM scores and change in scores over time were compared between the two groups. RESULTS The risk of death did not differ at 90 days (control group risk = 0.61%; 95% CI = 0.00-1.3; Parkinson's disease group risk = 0.62%; 95% CI = 0.00-1.31; p = 0.998) or 1 year (control group = 2.11%; 95% CI = 0.81-3.39; Parkinson's disease group = 2.56%, 95% CI = 1.12-3.97; p = 0.670). At 9 years, the risk of death was increased for patients with Parkinson's disease (control group = 28.05%; 95% CI = 22.29-33.38; Parkinson's disease group = 54.35%; 95% CI = 46.72-60.88; p < 0.001). The risk of revision did not differ at 90 days (control group = 0.41%; 95% CI = 0.00-0.98; Parkinson's disease group = 1.03%; 95% CI = 0.13-1.92; p = 0.256). At 1 year, the risk of revision was higher for patients with Parkinson's disease (control group = 0.41%; 95% CI = 0.00-0.98; Parkinson's disease group = 2.10%; 95% CIs = 0.80-3.38; p = 0.021). This difference was more pronounced at 9 years (control group = 1.75%; 95% CI = 0.11-3.36; Parkinson's disease group = 5.44%; 95% CI = 2.89-7.91; p = 0.001) when using the Kaplan-Meier method. There was no difference between the control and Parkinson's disease groups for level of pain relief at 1 year postoperatively (mean reduction in pain VAS score for control group = 48.85, SD = 20.46; Parkinson's disease group = 47.18, SD = 23.96; p = 0.510). Mean change in scores for quality of life and overall health from preoperative measures to 1 year postoperatively were smaller for patients in the Parkinson's disease group compared with controls (mean change in EQ-5D scores for control group = 0.42, SD = 0.32; Parkinson's disease group = 0.30, SD = 0.37; p 0.003; mean change in EQ VAS scores for control group = 20.94, SD = 23.63; Parkinson's disease = 15.04, SD = 23.00; p = 0.027). CONCLUSIONS Parkinson's disease is associated with an increased revision risk but not with short-term mortality rates relevant to assessing risk versus benefit before undergoing THR. The traditional reluctance to perform THR in patients with Parkinson's disease may be too conservative given that the higher long-term risk of death is more likely due to the progressive neurological disorder and not THR itself, and patients with Parkinson's disease report comparable outcomes to controls. Further research on outcomes in THR for patients with other neurological conditions is needed to better address the broader assumptions underlying this traditional teaching.Level of Evidence Level III, therapeutic study.
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Statz JM, Sierra RJ, Trousdale RT, Milbrandt TA. Total Hip Arthroplasty in Patients with Spasticity: A Critical Analysis Review. JBJS Rev 2019; 7:e10. [PMID: 31045687 DOI: 10.2106/jbjs.rvw.18.00115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joseph M Statz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Yli-Kyyny TT, Sund R, Heinänen M, Malmivaara A, Kröger H. Risk factors for early readmission due to surgical complications after treatment of proximal femoral fractures - A Finnish National Database study of 68,800 patients. Injury 2019; 50:403-408. [PMID: 30473368 DOI: 10.1016/j.injury.2018.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/15/2018] [Accepted: 10/27/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hip fracture surgery is associated with a considerable amount medical and surgical complications, which adversely impacts the patient's outcome and/or increases costs. We evaluated what risk factors were associated with the occurrence of early readmission due to surgical complications after hip fracture surgery. MATERIAL AND METHODS A nationwide database with 68,800 hip fracture patients treated between 1999 and 2011 was studied to uncover the association of readmissions with co-morbidities, fracture types, different hospital types and treatment methods using the Cox proportional hazards model. RESULTS Early readmission within three months due to hip fracture surgery complications occurred at a rate of 4.6%. Increased occurrence of readmission was found among patients with: heavy alcoholism (HR 1.38; 95% CI: 1.23-1.53); Parkinson's disease (PD; HR 1.22; 95% CI: 1.05-1.42); pre-existing osteoarthritis (HR 2.02; 95% CI: 1.83-2.23); rheumatic disease (HR 1.44; 95% CI: 1.27-1.65); as well as those with a fracture of the femur neck, depression, presence of a psychotic disorder, an operative delay of at least three days, or previous treatment with total hip arthroplasty. CONCLUSION Our results indicate that there are several factors associated with an increased risk of early readmission. We suggest that in the presence of these factors, the surgical treatment method and postoperative protocol should be carefully planned and performed.
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Affiliation(s)
- Tero T Yli-Kyyny
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.
| | - Reijo Sund
- Centre for Research Methods, Department of Social Research, University of Helsinki, Helsinki, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Heinänen
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Antti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland; Scientific Unit, Orton Orthopaedic Hospital, Helsinki, Finland
| | - Heikki Kröger
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Podmore B, Hutchings A, van der Meulen J, Aggarwal A, Konan S. Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis. BMJ Open 2018; 8:e021784. [PMID: 29997141 PMCID: PMC6082478 DOI: 10.1136/bmjopen-2018-021784] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To systematically perform a meta-analysis of the association between different comorbid conditions on safety (short-term outcomes) and effectiveness (long-term outcomes) in patients undergoing hip and knee replacement surgery. DESIGN Systematic review and meta-analysis. METHODS Medline, Embase and CINAHL Plus were searched up to May 2017. We included all studies that reported data to allow the calculation of a pooled OR for the impact of 11 comorbid conditions on 10 outcomes (including surgical complications, readmissions, mortality, function, health-related quality of life, pain and revision surgery). The quality of included studies was assessed using a modified Newcastle-Ottawa Scale. Continuous outcomes were converted to ORs using the Hasselblad and Hedges approach. Results were combined using a random-effects meta-analysis. OUTCOMES The primary outcome was the adjusted OR for the impact of each 11 comorbid condition on each of the 10 outcomes compared with patients without the comorbid condition. Where the adjusted OR was not available the secondary outcome was the crude OR. RESULTS 70 studies were included with 16 (23%) reporting on at least 100 000 patients and 9 (13%) were of high quality. We found that comorbidities increased the short-term risk of hospital readmissions (8 of 11 conditions) and mortality (8 of 11 conditions). The impact on surgical complications was inconsistent across comorbid conditions. In the long term, comorbid conditions increased the risk of revision surgery (6 of 11 conditions) and long-term mortality (7 of 11 conditions). The long-term impact on function, quality of life and pain varied across comorbid conditions. CONCLUSIONS This systematic review shows that comorbidities predominantly have an impact on the safety of hip and knee replacement surgery but little impact on its effectiveness. There is a need for high-quality studies also considering the severity of comorbid conditions.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/mortality
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/mortality
- Arthroplasty, Replacement, Knee/psychology
- Comorbidity
- Humans
- Patient Readmission/statistics & numerical data
- Postoperative Complications/epidemiology
- Quality of Life
- Recovery of Function
- Reoperation/statistics & numerical data
- Risk Factors
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Affiliation(s)
- Bélène Podmore
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Andrew Hutchings
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Sujith Konan
- Orthopaedics and Trauma, University College London Hospitals NHS Foundation Trust, London, UK
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Does Parkinson Disease Increase the Risk of Perioperative Complications After Total Hip Arthroplasty? A Nationwide Database Study. J Arthroplasty 2018; 33:S162-S166. [PMID: 29402715 DOI: 10.1016/j.arth.2018.01.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/19/2017] [Accepted: 01/04/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Parkinson disease (PD) is the second most common neurodegenerative disorder in the United States, affecting over 1 million people. As part of the disease process, PD can cause poor bone quality and other musculoskeletal problems that can affect a patient's quality of life. With advances in treatment, PD patients can be more active and may be candidates for total hip arthroplasty (THA). However, there is a paucity of literature on the outcomes of THA in PD patients. Therefore, the purpose of this study was to evaluate the perioperative outcomes of PD patients who underwent THA. Specifically, we assessed: (1) perioperative surgical and medical complications; (2) lengths of stay (LOSs); and (3) total hospital charges. METHODS Using the Nationwide Inpatient Sample, patients who had PD and underwent THA between 2002 and 2013 were identified. With the use of propensity scores, PD patients were matched in a 1:3 ratio to patients without PD by the year of surgery, age, gender, race, Charlson/Deyo score, and insurance type. This yielded a total of 10,519 PD and 31,679 non-PD THA patients. Regression analyses were used to compare the risk of perioperative complications (any, surgical, medical), the percent differences in mean LOS, and the percent differences in total hospital charges. RESULTS Compared with the matched cohort, PD patients had a 52% higher risk for any complication (odds ratio [OR] = 1.52; 95% confidence interval [CI], 1.37-1.69), a 30% higher risk for any surgical complication (OR = 1.30; 95% CI: 0.88-1.91), and a 54% higher risk for any medical complication (OR = 1.54; 95% CI, 1.38-1.71). Specifically, PD patients were more likely to have postoperative delirium (OR = 2.61; 95% CI: 1.77-3.85), altered mental status (OR = 3.01; 95% CI: 1.35-6.71), urinary tract infection (OR = 1.34; 95% CI: 1.09-1.76), and blood transfusion (OR = 1.62; 95% CI: 1.44-1.82). Also, PD patients had a mean LOS that was 8.57% longer (P < .0001), and mean total hospital charges that were 3.85% higher (P < .0001). CONCLUSION Orthopedic surgeons and neurologists should be involved in the preoperative counseling of PD patients regarding their potential increased risks associated with THA, which could help optimize their preoperative care. Furthermore, the risk of complications and higher costs could potentially lead to the development of different reimbursement methods in this population of patients.
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Sharma T, Hönle W, Handschu R, Adler W, Goyal T, Schuh A. Incidence of perioperative complications in total hip and knee arthroplasty in patients with Parkinson disease. Arch Orthop Trauma Surg 2018; 138:765-770. [PMID: 29450640 DOI: 10.1007/s00402-018-2899-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study is to evaluate the difference in perioperative complication rate in total hip, bipolar hemiarthroplasties and total knee arthroplasty in patients with Parkinson disease in trauma and elective surgery in our Musculoskeletal Center during a period of 10 years. MATERIAL AND METHOD Between 2006 and 2016, 45 bipolar hemiarthroplasties in trauma surgery, 15 total knee and 19 total hip arthroplasties in patients with Parkinson's disease were performed. We divided the patients in two groups. Group I included trauma cases (45) and group II elective surgery cases (34). Complications were documented and divided into local minor and major complications and general minor and major complications. Fisher's exact test was used for statistical evaluation. RESULTS In both groups, there was one local major complication (p > 0.05): In group I, there was one case of loosening of a K-wire which was removed operatively. In group II, there was one severe intraarticular bleeding requiring puncture of the hematoma. In group I, there were 38 general complications; in group II, there were 17 general complications. There was no statistical difference in complication rate (p > 0.05). CONCLUSION Total hip arthroplasty, bipolar hemiarthroplasties and knee arthroplasty in patients with Parkinson disease is possible in elective and trauma surgery. Complication rate is higher in comparison with patients not suffering from Parkinson disease, but there is no difference in complication rate in elective and trauma surgery. Nevertheless, early perioperative neurological consultation in patients with Parkinson disease is recommended to minimize complications and improve early outcomes after arthroplasty.
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Affiliation(s)
- Tankamani Sharma
- University of Erlangen-Nuremberg, Erlangen, Germany.,Musculoskeletal Center Neumarkt, Neumarkt Hospital, Teaching Hospital of the University of Erlangen-Nurenberg, Nürnberger Str. 12, Neumarkt i.d. OPf, 92318, Erlangen, Germany
| | - Wolfgang Hönle
- Musculoskeletal Center Neumarkt, Neumarkt Hospital, Teaching Hospital of the University of Erlangen-Nurenberg, Nürnberger Str. 12, Neumarkt i.d. OPf, 92318, Erlangen, Germany
| | - René Handschu
- Department of Neurology, Neumarkt Hospital, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Alexander Schuh
- Musculoskeletal Center Neumarkt, Neumarkt Hospital, Teaching Hospital of the University of Erlangen-Nurenberg, Nürnberger Str. 12, Neumarkt i.d. OPf, 92318, Erlangen, Germany.
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Abstract
BACKGROUND Prevention of dislocation after primary total hip arthroplasty (THA) begins with patient preoperative assessment and planning. METHODS We performed a literature search to assess historical perspectives and current strategies to prevent dislocation after primary THA. The search yielded 3458 articles, and 154 articles are presented. RESULTS Extremes of age, body mass index >30 kg/m2, lumbosacral pathology, surgeon experience, and femoral head size influence dislocation rates after THA. There is mixed evidence regarding the effect of neuromuscular disease, sequelae of pediatric hip conditions, and surgical approach on THA instability. Sex, simultaneous bilateral THA, and restrictive postoperative precautions do not influence the dislocation rates of THA. Navigation, robotics, lipped liners, and dual-mobility acetabular components may improve dislocation rates. CONCLUSIONS Risks for dislocation should be identified, and measures should be taken to mitigate the risk. Reliance on safe zones of acetabular component positioning is historical. We are in an era of bespoke THA surgery.
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Lee CK, Choi SK, Shin DA, Yi S, Kim KN, Kim I, Ha Y. Parkinson's disease and the risk of osteoporotic vertebral compression fracture: a nationwide population-based study. Osteoporos Int 2018; 29:1117-1124. [PMID: 29460103 DOI: 10.1007/s00198-018-4409-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/24/2018] [Indexed: 01/23/2023]
Abstract
UNLABELLED Patients with Parkinson's disease (PD) were at higher risk of osteoporotic vertebral compression fractures (OVCF) compared to controls and had elevated mortality rates. Compared to conservative treatment, surgical treatment for OVCF in PD patients seemed to be associated with better outcomes. INTRODUCTION The purpose of this study was to evaluate the risk of OVCF in patients with PD. METHODS Data from patients over the age of 60 years who were diagnosed with PD were collected between 2004 and 2013 from the Korean National Health Insurance Database (n = 3370). The comparison group (non-PD) consisted of randomly selected patients (five per patient with PD; n = 16,850) matched to the PD group, who were newly diagnosed annually according to age and sex. Cox proportional hazard regressions were used to examine the relationships between osteoporosis, OVCF, surgery for OVCF, and PD. Household income and residential area of patients were also assessed. Overall survival rates were calculated after adjusting for confounding factors, such as hypertension, diabetes mellitus, and chronic kidney disease. RESULTS OVCF was developed in 12.5% of patients in the PD group and in 7.4% of patients in the control group. PD was associated with increased risk of osteoporosis (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.21-1.43; p < 0.001), OVCF (HR 1.66; 95% CI, 1.47-1.87; p < 0.001), and surgery for OVCF (HR 2.69; 95% CI, 1.78-4.08; p < 0.001). Household income was not significantly related with development of osteoporosis, incidence of OVCF, or surgery for OVCF. Residential area was statistically associated with osteoporosis, OVCF, and surgery for OVCF. The mortality rate of the PD group was about 1.7 times higher than that of the non-PD group after adjusting for potential confounders, and the mortality rate of the PD with OVCF group was higher than that of the non-PD group, but not significantly (p = 0.09). The survival rate of the PD group with surgery for OVCF showed a trend toward a more positive prognosis compared with that of the PD group with conservative treatment. CONCLUSIONS Patients with PD had significantly increased risk of osteoporosis and OVCF. Surgical treatment for OVCF in PD patients was associated with a better prognosis than conservative treatment.
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Affiliation(s)
- C K Lee
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S K Choi
- Biostatistics and Epidemiology, Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - D A Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - K N Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - I Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Y Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Gausden EB, Parhar HS, Popper JE, Sculco PK, Rush BNM. Risk Factors for Early Dislocation Following Primary Elective Total Hip Arthroplasty. J Arthroplasty 2018; 33:1567-1571.e2. [PMID: 29395718 DOI: 10.1016/j.arth.2017.12.034] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dislocation following total hip arthroplasty (THA) continues to be one of the most common reasons for revision THA. The purpose of this study is to measure the current rate of dislocation following THA in the United States. A secondary goal is to identify patients at highest risk of instability after THA. METHODS The Nationwide Readmissions Database was used to identify cases of elective primary THA between 2012 and 2014. All readmissions associated with dislocations were identified. Kaplan-Meier curves were used to assess the time to dislocation in the study population. A multivariate logistic regression was modeled to assess risk factors associated with readmission for dislocation. RESULTS A total of 207,285 THAs were identified between 2012 and 2014. Of the total, 2842 dislocation-associated readmissions (1.4%) were identified, at a median of 40 days post-THA. A history of spinal fusion was the strongest independent predictor of dislocation (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.97-3.04; P < .0001). Parkinson's disease was also significantly associated with dislocation (OR, 1.63; 95% CI, 1.05-2.51; P = .03), as well as dementia (OR, 1.96; 95% CI, 1.13-3.39; P = .02), depression (OR, 1.28; 95% CI, 1.13-1.43; P < .0001), and chronic lung disease (OR, 1.2; 95% CI, 1.07-1.33; P = .001). Inflammatory arthritis and avascular necrosis were independent risk factors for dislocation (OR, 1.56; 95% CI, 1.25-1.97; P < .0001; OR, 1.67; 95% CI, 1.45-1.93; P < .0001). CONCLUSION THA is a highly effective procedure with a low overall rate of instability. A history of spinal fusion was the most significant independent risk factor for dislocation within the first 6 months following THA.
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Affiliation(s)
- Elizabeth B Gausden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Harman S Parhar
- Division of Otolaryngology, Department of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Joseph E Popper
- Department of Spine Surgery, Mohawk Valley Orthopaedics, Johnstown, New York
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Barret N M Rush
- Division of Otolaryngology, Department of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia Canada; Harvard T.S. Chan School of Public Health, Boston, Massachusetts
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Lazennec JY, Kim Y, Pour AE. Total Hip Arthroplasty in Patients With Parkinson Disease: Improved Outcomes With Dual Mobility Implants and Cementless Fixation. J Arthroplasty 2018; 33:1455-1461. [PMID: 29276118 DOI: 10.1016/j.arth.2017.11.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/25/2017] [Accepted: 11/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Parkinson disease (PD) results in severe limitation in ambulation caused by abnormality of gait and posture. The rate of complications, including fractures and dislocation after total hip arthroplasty (THA), can be higher among these patients. The goal of this study was to investigate the long-term outcomes of primary and revision THAs with cementless dual mobility implants. METHODS This retrospective study examines 59 PD patients who had surgery between 2002 and 2012. All the primary cases were performed for osteoarthritis and all patients received cementless acetabular implants with dual mobility bearing surface. The femoral stem was cemented in 4 patients who underwent revision surgery. The mean follow-up time was 8.3 years (4-14 years). RESULTS Good to excellent pain relief was achieved in 53 of 57 patients at the 2-year follow-up and in 40 of 47 patients at their latest follow-up. The most common medical complication was cognitive impairment (12 of 57 patients). One patient sustained an intraprosthetic hip dislocation 9 years after surgery, which required revision. Four patients sustained periprosthetic femoral fractures with well-fixed stem, requiring open reduction and internal fixation. The disability had increased in 68% of the patients in the latest follow-up visit. DISCUSSION Our study shows that elective primary or revision THA using cementless implants with dual mobility bearing surface in patients with PD provides satisfactory long-term outcomes, although many of these patients may see a general worsening of their activities over time due to PD.
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Affiliation(s)
- Jean Y Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France; Anatomy Department Faculté Pitie Salpetriere UPMC, Paris, France
| | - Youngwoo Kim
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Aidin Eslam Pour
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Rondon AJ, Tan TL, Schlitt PK, Greenky MR, Phillips JL, Purtill JJ. Total Joint Arthroplasty in Patients With Parkinson's Disease: Survivorship, Outcomes, and Reasons for Failure. J Arthroplasty 2018; 33:1028-1032. [PMID: 29199060 DOI: 10.1016/j.arth.2017.11.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Gait instability and muscle rigidity are known characteristics of Parkinson's disease (PD), putting PD patients at risk for complications following total joint arthroplasty (TJA). The outcomes of Parkinson's patients undergoing TJA are largely unknown. This study evaluated the outcomes of TJA in this population. METHODS A single institution retrospective cohort of 123 TJAs (52 hips, 71 knees) from 2000 to 2016 was reviewed. An electronic chart query was performed using International Classification of Diseases, Ninth revision codes to identify this population. A manual chart review was performed to confirm the diagnosis of PD, survivorship, and reason for failure. A control cohort was matched 2:1 based on age, body mass index, joint, and comorbidities. Outcomes were assessed using revision for any reason as the primary endpoint. Functional outcomes were assessed using Short-Form 12 scores. RESULTS At an average follow-up of 5.3 years, 23.6% of patients required revision surgery. The most common reasons for revision for total knee arthroplasty (TKA) were periprosthetic infection and for total hip arthroplasty (THA) were periprosthetic fracture and dislocation. Overall survivorship of TJA at years 2, 5, and 10 respectively were 94.9%, 87.9%, and 72.3%. The survivorship of TKA was 95.2%, 89.8%, and 66.2%. THA implant survivorship was 94.3%, 85.3%, and 78.7%. Functional score improvement was less in PD cohort than the control. CONCLUSION Patients with PD are at increased risk for complications, particularly periprosthetic infection following TKA and periprosthetic fracture and dislocation following THA. Despite this increased risk of complications, patients with PD can demonstrate improved functional outcomes but not as high as patients without PD. Patients with PD should be counseled appropriately prior to undergoing TJA.
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Affiliation(s)
- Alexander J Rondon
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L Tan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Patrick K Schlitt
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Max R Greenky
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jessica L Phillips
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James J Purtill
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Ashraf M, Priyavadhana S, Sambandam SN, Mounasamy V, Sharma OP. Total Knee Arthroplasty In Patients With Parkinson's Disease- A Critical Analysis of Available Evidence. Open Orthop J 2017; 11:1087-1093. [PMID: 29152001 PMCID: PMC5676002 DOI: 10.2174/1874325001711011087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/16/2017] [Accepted: 07/18/2017] [Indexed: 01/26/2023] Open
Abstract
Background: In this era of modern medicine, there is an increase in life expectancy and thereby an ageing population. Among this group one of the most common neurological disorder is Parkinson disease and one of the most common operation done in elderly population is a total joint arthroplasty. But total joint arthroplasty in Parkinson disease is a relatively uncommon entity. There is sparse literature available with regards to total knee arthroplasty (TKA) in Parkinson disease. This review focusses on the necessity, complications and previous experiences on TKA in PD based on the literature available. Method: The review was conducted after a series of advanced search in the following medical databases; Pub med, Biomed central, Cochrane and Google scholar for articles related to total knee replacement in patients with Parkinson’s disease. The following keywords were used; Total knee arthroplasty, Parkinson’s disease, Hoehn and Yahr, Flexion Contracture. Results: The review indicates that the functional outcome is comparable to that of controls in immediate post-operative phase, one year and three-year phase, but the long term functional outcome seems to deteriorate significantly. Conclusion: Total knee arthroplasty can serve as an effective tool in alleviating pain in short term as well as long term periods, whereas the functional outcome seems to deteriorate post operatively on a long-term basis. Nevertheless, TKA in PD is a challenging situation, thereby necessitating a holistic approach with the efforts from various specialists needed at each stage to ensure a successful operation.
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Affiliation(s)
- Munis Ashraf
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore 641018, Tamil Nadu, India
| | | | - Senthil Nathan Sambandam
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore 641018, Tamil Nadu, India
| | - Varatharaj Mounasamy
- VCU Medical Center Ambulatory Care Center, 417 North 11th Street, Richmond, Virginia, USA
| | - Om Prakash Sharma
- Orthopedic surgeon Essentia Health St.Mary's Detroit Lakes Clinic, Minnesota, USA
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The Outcomes of Total Hip Replacement in Patients with Parkinson's Disease: Comparison of the Elective and Hip Fracture Groups. PARKINSONS DISEASE 2017; 2017:1597463. [PMID: 29090105 PMCID: PMC5635275 DOI: 10.1155/2017/1597463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/29/2017] [Accepted: 08/13/2017] [Indexed: 12/21/2022]
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.
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Abstract
Parkinson disease (PD) is increasingly prevalent in the aging population. Spine disorders in patients with PD may be degenerative in nature or may arise secondary to motor effects related to the parkinsonian disease process. Physicians providing care for patients with PD and spine pathologies must be aware of several factors that affect treatment, including the patterns of spinal deformity, complex drug interactions, and PD-associated osteoporosis. Following spine surgery, complication rates are higher in patients with PD than in those without the disease. Literature on spine surgery in this patient population is limited by small cohort size, the heterogeneous patient population, and variable treatment protocols. However, most studies emphasize the need for preoperative optimization of motor control with appropriate medications and deep brain stimulation, as well as consultation with a movement disorder specialist. Future studies must control for confounding variables, such as the type of surgery and PD severity, to improve understanding of spinal pathology and treatment options in this patient population.
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Mortality and morbidity after spinal surgery in patients with Parkinson's disease: a retrospective matched-pair cohort study. Spine J 2017; 17:531-537. [PMID: 27884743 DOI: 10.1016/j.spinee.2016.10.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 09/24/2016] [Accepted: 10/25/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson's disease (PD). PURPOSE This study aimed to investigate the postoperative morbidity and mortality associated with spinal surgery for patients with PD, and the risk factors for poor outcomes. STUDY DESIGN This is a retrospective matched-pair cohort study. PATIENT SAMPLE Data of patients who underwent elective spinal surgery between July 2010 and March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. OUTCOME MEASURES In-hospital mortality and occurrence of postoperative complications. METHODS For each patient with PD, we randomly selected up to four age- and sex-matched controls in the same hospital in the same year. The differences in in-hospital mortality and occurrence of postoperative complications were compared between patients with PD and controls. A multivariable logistic regression model fitted with a generalized estimation equation was used to identify significant predictors of major complications (surgical site infection, sepsis, pulmonary embolism, respiratory complications, cardiac events, stroke, and renal failure). Multiple imputation was used for missing data. RESULTS Among 154,278 patients undergoing spinal surgery, 1,423 patients with PD and 5,498 matched controls were identified. Crude in-hospital mortality was higher in patients with PD than in controls (0.8% vs. 0.3%, respectively). The crude proportion of major complications was also higher in patients with PD (9.8% vs. 5.1% in controls). Postoperative delirium was more common in patients with PD (30.3%) than in controls (4.3%). Parkinson's disease was a significant predictor of major postoperative complications, even after adjusting for other risk factors (odds ratio, 1.74; 95% confidence intervals, 1.37-2.22; p<.001). CONCLUSIONS Patients with PD had a significantly increased risk of postoperative complications following spinal surgery. Postoperative delirium was the most frequently observed complication.
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Schuh A, Handschu R, Schwemmer U, Krautz B, Hönle W. [Total hip and total knee arthroplasty in parkinson's disease]. MMW Fortschr Med 2017; 159:52-54. [PMID: 28168465 DOI: 10.1007/s15006-017-9219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Alexander Schuh
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Nürnberger Str. 12, D-92318, Neumarkt, Deutschland.
| | - René Handschu
- Neurologische Klinik, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt, Deutschland
| | - Ulrich Schwemmer
- Klinik für Anästhesiologie und Intensivmedizin, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt, Deutschland
| | - Bernhard Krautz
- Leitung Pflegedienst, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt, Deutschland
| | - Wolfgang Hönle
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt, Deutschland
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