Parkinson’s disease associated with complications, inferior outcomes after reverse TSA
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Patients with Parkinson’s disease who undergo reverse total shoulder arthroplasty may experience more complications and revisions than neurologically healthy patients, according to published results.
By review of medical records, researchers compared outcomes of 17 patients (mean age of 73.9 years) with Parkinson’s disease (PD) who underwent reverse total shoulder arthroplasty with a healthy cohort of 68 patients of the same mean age. According to the study, outcome measures included complication and revision rates, Constant–Murley score (CMS), subjective shoulder value (SSV) and functional outcomes.
Researchers found that while both groups experienced improvements, the control group demonstrated “significantly greater improvements” in postoperative CMS, SSV, flexion, abduction and overall strength at a mean follow-up of 49.5 months. They also noted the PD group had higher rates of postoperative complications (35% vs. 6% in the control group) and re-interventions (29% vs. 1% in the control group). Fractures of the scapular spine and the acromion were the most commonly reported complications in the PD group.
“The risk of needing revision is approximately 30%; however, despite this, patients with PD can expect to have significant improvement over their preoperative state,” the researchers wrote in the study. “The particularly high risk of fracture of the acromion or the scapular spine should be pointed out during informed consent,” they concluded.
Perspective
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Despite the popularity of reverse total shoulder arthroplasty (RTSA), it remains a procedure in which the preoperative diagnosis and associated patient comorbidities have a profound effect on perioperative complications and ultimate patient satisfaction. I read with interest the article “The influence of Parkinson’s disease on outcome and complication rate of reverse total shoulder arthroplasty: A matched group analysis” by Borbas and colleagues from Balgrist University Hospital in Zurich. The authors presented a retrospective 2-year minimum case control comparison of patients with early-stage Parkinson’s disease (PD) and a healthy comparison cohort. The investigators found that patients in the control group demonstrated significantly greater improvements in subjective outcomes, motion and strength as compared to the PD group. More importantly, the risk of complication (35% vs. 6%) and revision surgery (29% vs. 1%) was substantially higher in the PD group as compared to controls, with fracture of the scapular spine and acromion representing the most common complications.
This study highlights the influence of neurological health on the outcomes of RTSA and also underscores the importance of perioperative risk assessment in the counseling of prospective shoulder replacement candidates. PD certainly effects neuromuscular control and may increase the risk of falls that result in dislocation, periprosthetic fracture or scapular spine fracture. Neuromuscular disorders are also associated with higher rates of depression and anxiety, which may negatively affect patient satisfaction. It is interesting that the authors only included patients with mild to moderate-stage PD in this study, as patients with severe impairment were not even considered candidates for RTSA.
Despite these findings, it is important to note that during the study period, patients in both the control and PD cohorts demonstrated significant improvements in all outcome parameters. Consequently, RTSA can be appropriately indicated in thoughtfully selected PD patients if they are counseled as to the increased complication rate associated with their diagnosis. Patients with mild or slowly progressive disease may be suitable candidates; however, larger prospective long-term studies are required for accurate risk stratification.
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