Joint Replacement Surgery in Parkinson's Disease

Abstract

Parkinson Disease affects 4 million people worldwide and it is the second most common neurological disorder after Alzheimer disease (Huse et al. 2005). It occurs in 1% of the population over the age of 60 years (Adams et al. 1997). The annual incidence of Parkinson’s disease is 20.5 per 100,000 (Rajput et al. 1984) and can result in numerous symptoms including tremor, muscular rigidity and abnormalities of gait, posture and facial expression. Despite optimal pharmacological treatment, progression of Parkinson’s disease normally results in a decline in general mobility and ability to ambulate safely. Rigidity secondary to Parkinson’s Disease often aggravates joint pain from osteoarthritis (Adams et al. 1997). The outcome of joint arthroplasty in these patients is effective in relieving pain, but the overall functional results have been found to be variable (Oni et al. 1985; Vince et al. 1989; Duffy et al. 1996; Koch et al. 1997; Weber et al. 2002; Shah et al. 2005; Kryzak et al. 2009; Kryzak et al. 2010). A report from the Scottish joint registry has found an annual prevalence of Parkinson’s disease of 5% to 8% in patients undergoing total hip arthroplasty (Meek et al. 2006). Optimal management of the disease before, during and after surgery is a challenge due to the neurological disturbances in Parkinson’s disease including tremor, rigidity, contractures and gait abnormalities. We will firstly provide an overview of the difficulties faced when planning surgery in patients with Parkinson’s disease before discussing specific pre-, intraand post-operative measures that should be taken. Finally we will provide an overview of the evidence available for arthroplasty in Parkinson’s disease specific to the three major joints replaced – hip, knee and shoulder.