Thursday, July 23, 2015

Shoulder joint replacement arthroplasty in patients with Parkinson's disease

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

Using a national insurance database (PearlDiver Patient Records Database) for the years 2005 to 2012, these authors evaluated
(a) 3390 patients with Parkinson's disease (PD) having total shoulder arthroplasty (TSA) and 47,034 matched controls;
(b) 809 patients with Parkinson's disease having reverse shoulder arthroplasty (RSA) and 14,262 matched controls; and 
(c) 2833 patients with Parkinson's disease having hemiarthroplasty (HA) and 38,850 matched controls. 

For these three procedures, Parkinson's disease was associated with significant higher rates of 6 month infection (odds ratio [OR], 1.5, 1.7, 1.5, respectively), dislocation within 1 year (OR, 2.5, 2.0, 2.8, respectively), revision arthroplasty up to 8 years (OR, 1.7, 1.8, 1.4, respectively), and systemic complications within 3 months (OR, 1.4, 1.7, 1.3, respectively) after all 3 types of shoulder arthroplasty and with higher rates of periprosthetic fracture after conventional TSA (OR, 1.5) and shoulder HA (OR, 1.5). Component loosening was also more commonly noted in patients with PD after conventional TSA (OR, 1.5) and HA (OR, 1.9).

Comment: One of the the remarkable aspects of this paper is the high incidence of Parkinson's disease in those over 65 years of age (1-2%) and the large number of patients with this condition that receive shoulder arthroplasty.

It is our impression that shoulder arthritis and Parkinson's disease aggravate each other. Our patients having shoulder arthroplasty are usually substantially improved with respect to their shoulder comfort and function. This investigation supports our current practice of having detailed preoperative discussions with patients having Parkinson's disease about their increased risk of complications, about optimizing the control of their disease, about minimizing their fall risk (railings, lighted stairways, vision correction, balance training, etc), about preoperative medicine consultation and about use of surgical techniques to minimize the risk of fracture should a fall occur (impaction grafting for fixation of the humeral stem, great attention detail in component fixation and subscapularis repair). 


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