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Review
. 2023 Nov;15(11):2993-2999.
doi: 10.1111/os.13879. Epub 2023 Sep 15.

Levodopa-Carbidopa Intestinal Gel Injection for Patient with Severe Parkinson's Disease Followed by Total Hip Arthroplasty: A Case Report and Literature Review

Atsushi Imamura  1 , Gen Kuroyanagi  1   2 , Takuya Usami  1   3 , Toyohiro Sato  4 , Mitsuya Horiba  2 , Hiroaki Sakai  1 , Ayaka Takahashi  1 , Yoshino Ueki  2 , Noriyuki Matsukawa  4 , Hideki Murakami  1
Affiliations
Review

Levodopa-Carbidopa Intestinal Gel Injection for Patient with Severe Parkinson's Disease Followed by Total Hip Arthroplasty: A Case Report and Literature Review

Atsushi Imamura et al. Orthop Surg. 2023 Nov.

Abstract

Background: Patients with Parkinson's disease have a high dislocation rate after total hip arthroplasty (THA). This study describes a case with severe Parkinson's disease who developed rapidly destructive coxarthrosis (RDC) and underwent THA using a dual mobility cup after a levodopa-carbidopa intestinal gel (LCIG) infusion.

Case presentation: The patient is a 59-year-old female with a ten-year history of Parkinson's disease, which was first treated with oral levodopa. The patient developed RDC of the right hip joint. However, THA was difficult owing to Parkinson's disease and its treatment side effects, such as wearing-off, dyskinesia, and freezing of the gait, Thus, LCIG was initiated, and improvement in wearing-off and dyskinesia was observed. Two months after the LCIG therapy, the disease was controlled well. THA was subsequently performed using a dual mobility cup to prevent postoperative dislocation. Postoperatively, LCIG therapy was continuously administered to carefully manage the disease, which was controlled well with no increase in wearing-off and dyskinesia after surgery. At 1 year after surgery, the walking speed, stride length, and the Harris hip score improved compared to preoperatively. The UPDRS III motor score improved to eight without signs of wearing-off or dyskinesia. The Hoehn-Yahr scale was II in the "on" period and remained unchanged 1 year after surgery. The patient could walk without a cane and had satisfactory functional outcomes.

Conclusion: This case proved that LCIG treatment performed preoperatively, followed by THA using a dual mobility cup, and strict management of Parkinson's disease could result in a satisfactory clinical course without recurrence of wearing-off and dyskinesia. Similar procedures may benefit other patients with Parkinson's disease who have previously been deemed unsuitable for THA.

Keywords: Intestinal levodopa-carbidopa gel infusion; Parkinson's disease; Rapidly destructive coxarthrosis; Total hip arthroplasty.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article.

Figures

FIGURE 1
FIGURE 1
Plain radiograph of the hip joint before surgery. The right femoral head had disappeared and the femur was shortened upward. A narrowing of the joint space was observed in the left hip joint.
FIGURE 2
FIGURE 2
Plain radiograph of the hip joint after surgery. A right THA with subtrochanteric osteotomy was performed.
FIGURE 3
FIGURE 3
Plain radiograph of the hip joint 1 year after operation. Bone union at the osteotomy site was observed.
FIGURE 4
FIGURE 4
Plain radiograph of the hip joint showing the seven femoral zones and the three acetabular zones 18 months after operation. Radiolucent line in zone 3 and cortical hypertrophy in zone 2 were observed with no stem subsidence.
FIGURE 5
FIGURE 5
A schematic illustration shows a procedure in the management of patients with Parkinson's disease with hip disorders.
See this image and copyright information in PMC

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