Patients with Parkinson’s disease had higher risk of periprosthetic dislocation after TSA
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Published results showed patients with Parkinson’s disease who underwent total shoulder arthroplasty had higher odds of periprosthetic dislocation, but equivalent rates of implant survival, compared with patients without the disease.
“As patients with [Parkinson’s disease] maintain greater mobility later in life based on advances in surgical and non-surgical treatments for [Parkinson’s disease], elective total shoulder replacement may increasingly be considered. The results of our study suggest that surgeons and patients should be aware of specific short-term risk of implant instability but should have confidence in long-term implant survival,” Harold G. Moore, BS, lead author of the study, told Healio.
Using the PearlDiver Mariner administrative database from 2010 to 2018, Moore and colleagues matched 478 patients with Parkinson’s disease undergoing TSA for osteoarthritis by age, gender, Elixhauser Comorbidity Index, diabetes, chronic kidney disease, obesity, coronary artery disease and congestive heart failure to 4,715 patients without Parkinson’s disease undergoing TSA for OA. Researchers compared 90-day incidence of adverse events using multivariate regressions and assessed implant survival for up to 5 years based on occurrence of revision surgery.
After adjusting for demographic and comorbid factors, results showed a significantly higher odds of prosthetic dislocation in patients with Parkinson’s disease; however, researchers found patients with Parkinson’s disease did not experience increased odds of other 90-day adverse events. Researchers noted 89.5% of patients with Parkinson’s disease and 80.5% of patients without Parkinson’s disease had 5-year follow-up data. Patients with Parkinson’s disease had an implant survival of 97.2%, while patients in the matched cohort had an implant survival of 97.7%, according to results.
“The next step in future research will be to stratify [Parkinson’s disease] patients by severity of Parkinson’s disease, as well as evaluate the underlying causes of the observed increased instability which could be due to falls, muscle imbalances or implant positioning,” Moore said.
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April D. Armstrong, BSc(PT), MSc, MD, FRCSC, FAOA
I read this article with interest. The authors use a multivariant analysis with an age- and comorbidity-matched cohort to investigate outcomes after TSA in 428 patients with Parkinson’s disease. Short-term results showed that patients with Parkinson’s disease had a higher odds ratio of prosthetic dislocation (OR=3.07) but no increased odds of other 90-day adverse events. At 5 years, they found no change in implant survival (97%) compared with those patients without Parkinson’s disease.
This is important information to educate the patient and the family regarding expected complications and outcomes. It seems that the complications typically are early and more often joint dislocation. The authors were not able to distinguish outcomes comparing anatomic vs. reverse TSA. Future study should strive to investigate the difference between these two reconstruction options for patients with Parkinson’s disease.
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