Clinical outcomes in elective total hip arthroplasty in Parkinson's disease: a systematic review of the literature

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.

Keywords: Parkinson’s disease; articulation; clinical outcomes; constrained liners; mortality rate; surgical site infection; systematic review; total hip arthroplasty.

Fig. 1

Flow diagram depicting the phases of literature search.

Table 1.

Participants’ and studies’ characteristics Notes. PD, Parkinson’s disease; THA, total hip arthroplasty; NOF, neck of femur; TKR, total knee replacement; OA, osteoarthritis; RC, retrospective case series; RCS, retrospective cohort study; N/R: not reported, RCC: retrospective case-control; N, number of patients; EQ-5D, EuroQol- 5 Dimension; EQ VAS, EuroQol-visual analogue scales. *Authors report that cells with a frequency between n = 1 and 11 were suppressed due to data use agreement.

Table 3.

Surgical complications Note. PD, Parkinson’s disease; THA, total hip arthroplasty; NOF, neck of femur; TKR, total knee replacement; OA, osteoarthritis; HR, hazard ratio; N/R, not reported. Categorical data presented as number/sample size (percentage) *Cells with frequency < 11 were suppressed owing to requirements in the data use agreement. ^$The percentage represents the indications for revisions not the percentage of complications.

Table 4.

Medical complications Notes. PD, Parkinson’s disease; THA, total hip arthroplasty; NOF, neck of femur; TKR, total knee replacement; OA, osteoarthritis; N/R, not reported; MI, myocardial infarction; CVA, cerebrovascular accident; UTI, urinary tract infection; PE: Pulmonary Embolism. Data presented as number/sample size (percentage). ^$Median (interquartile range).