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Introduction
The knee in Parkinson’s disease (PD) patients is a problematic joint due to pain, stiffness and gait instability. The aim of this study is to evaluate the functional outcome and degree of pain relief achieved after total knee arthroplasty (TKA) in PD patients.
Materials and methods
This is a retrospective review of 26 PD patients (32...
Citations
... Patients with PD often have knee OA. The knee joint poses difficulties for PD patients in the advanced stages of the disease, causing pain, stiffness, and instability that may require TKA [93]. However, associated orthopedic conditions, such as a high risk of falls and fractures, rigidity, and poor bone quality in PD patients, can make THA challenging for arthroplasty surgeons [53,72]. ...
... Additionally, they showed that the functional results of TKA in patients were closely associated with the progression of PD [100]. In another study, Montiel Terrón et al. [93] retrospectively examined 26 patients with PD and OA who underwent TKA. The mean follow-up was 3.5 years (2-9 years). ...
... While patients in the early stages had a higher chance of functional outcome deterioration, pa- tients with more progressive PD tended to remain stable after five years. They had a better outcome after surgery [93]. Therefore, it can be concluded that the functional outcomes of PD patients after TKA are correlated with the severity and progression of PD, and doctors should help delay PD progression to optimize TJA outcomes [25,71,99]. ...
... Two of the included studies reported the results of TKA in patients with PD without a control group [12,15]. Both studies showed statistically significant improvement in clinical score, pain reduction, and increased range of motion (ROM) after TKA in patients with PD. ...
... Among the studies, 11 studies reported postoperative complications (Table 4). Two studies reported only the complications that occurred in the PD group, which included gastrointestinal disorders, delirium, upper respiratory infection, confusion, and flexion contracture [12,15]. In another two studies, complications such as infection, urinary retention, and deep vein thrombosis were reported in both groups [9,16]. ...
... For medical and surgical complications that may occur after TKA, the definition and inclusion of complications were different for each study, and the probability of complications was also low; therefore, the two groups could not be statistically compared. In four studies included in the analysis, only the types of complications that occurred were presented, but no comparison was made between the two groups [9,12,15,16]. In a registry-based cohort study involving a large number of patients, the risk of medical complications was reported differently [1,21]. ...
Purpose:
The purpose of this systematic review was to determine the effect of Parkinson's disease (PD) on clinical outcomes and complications after total knee arthroplasty (TKA). Our systematic review was conducted to answer the following questions: (1) does TKA negatively affect clinical outcomes in patients with PD? and (2) does TKA cause more complications in patients with PD?
Methods:
A rigorous and systematic approach was used, and each selected study was evaluated for methodological quality. Data on study design, total number of cases enrolled, follow-up duration, PD severity, clinical outcome, and complications after TKA were analyzed.
Results:
Fourteen studies were included. Nine studies reported clinical scores. TKA significantly increased knee and functional scores in the PD group. However, compared with knee and functional scores in the non-PD group, the increase in scores in the PD group was not statistically significant, but tended to be less than that in the non-PD group. Eleven studies reported complications. In six studies, there was no difference in the complication rate between the PD and non-PD group or did not include a control group. In five studies, the PD group had higher medical complication rates and similar or higher surgical complication rates than the non-PD group.
Conclusions:
Patients with PD who underwent TKA showed satisfactory functional improvement and pain reduction. However, these outcomes were not as good as those in the non-PD group. The PD group had a higher probability of occurrence of medical complications than the non-PD group. Further, the PD group had a similar or higher surgical complication rate than the non-PD group.
... In 2021, Montiel Terrón et al. evaluated the functional outcomes achieved after TKA in patients with PD. They performed a retrospective review of 26 patients (32 knees) with PD and OA who had undergone TKA (11). The patients' functional status was assessed with the KSFS and the KSS. ...
... Function improved from 32 (range: 20-45) to 71 (range: 50-81) and from 34 (range: 28-52) to 59 (range: 25-76) on the KSS and KSFS, respectively. Functional outcome was related to disease progression and therefore variable (11). ...
... In 2021, Montiel Terrón et al. found that pain on the VAS improved from 8 points preoperatively to 5 points at 1-year follow-up. TKA successfully relieved pain in patients with PD (11). ...
Parkinson’s disease (PD) is a common neurodegenerative disorder.
When patients with PD undergo total knee arthroplasty (TKA) for knee osteoarthritis, poorer knee function and poorer quality of life are obtained than in matched cohorts (MCs). However, the degree of patient satisfaction is usually high.
The mean length of stay is 6.5% longer in patients with PD than in MCs.
Compared with MCs, patients with PD undergoing TKA have a 44% higher risk of complications.
In patients with PD, the overall complication rate is 26.3% compared with 10.5% in MCs; the periprosthetic joint infection rate is 6.5% in patients with PD vs 1.7% in MCs; and the periprosthetic fracture rate is 2.1% in patients with PD vs 1.7% in MCs.
The 90-day readmission rate is 16.29% in patients with PD vs 12.66% in MCs. More flexion contractures occur in patients with PD.
The rate of medical complications is 4.21% in patients with PD vs 1.24% in MCs, and the rate of implant-related complications is 5.09% in patients with PD vs 3.15% in MCs. At 5.3 years’ mean follow-up, the need for revision surgery is 23.6%.
The 10-year implant survival, taking revision of any of the components as an endpoint, is 89.7% in patients with PD vs 98.3% in MCs.
... However, no studies have reported the improvement of QOL in PD patients after TKA. Montiel et al [41]. questioned the improvement of QOL in PD patients after TKA, but did not draw a conclusion on whether QOL was improved or not. ...
... These results indicate that patients with PD have a poorer improvement in QOL after TKA compared to patients with KOA alone, but still relieve symptoms or pain related disability. The results are not entirely consistent with the view that TKA can signi cantly improve pain in PD patients [40,41].More importantly, all of these results indicate that there was no signi cant improvement in overall QOL after TKA in the PD patient. The reason why the QOL of PD patients cannot be signi cantly improved after TKA is not clear. ...
Background: The number of Parkinson's patients (PD) undergoing total knee arthroplasty (TKA) is increasing. The purpose of the study was to characterize quality of life (QOL) outcomes for patients with coexisting PD and knee osteoarthritis (KOA) following TKA.
Methods: Patients with coexisting PD and KOA undergoing TKA between June 2014 and June 2020 were included. These patients were matched to controls with KOA alone by age, gender, basic social background information and Knee society score（KSS）. The primary measure was to assess the QOL by the absolute changes in the EuroQOL5-Dimensions (EQ-5D), Pain and Disability Questionnaire (PDQ), and Patient Health Questionnaire-9(PHQ-9) at the last follow-up (LFU). Secondary measures were changes in QOL that exceeded the minimum clinically important difference value (MCID). Data on the health status and QOL of all patients were collected. Simple and multivariate regression analysis was used to evaluate the impact of PD on their QOL.
Results: Twelve KOA patients with PD were compared with 48 controls. Control patients experienced QOL improvement across all three measures：EQ-5D index (0.545-0.717, P <0.01), PDQ (81.1-52.3, P < 0.01) and PHQ-9(8.22-5.91, P < 0.01) were significantly improved at the LFU; while in patients with PD, only PDQ (91.0-81.4, P =0.03) slightly improved. There were significant differences in the improvement of QOL between PD patients and the control group through EQ-5D (0.531 vs.0.717, P< 0.01) and PDQ (81.4vs.52.3, P <0.01) at the LFU.
Conclusion: TKA has no benefit of QOL beyond a slight improvement in pain-related disability in the KOA patients with PD.
... Rondon and colleagues reported higher rates of periprosthetic infection in patients with PD who had TKA compared with controls (12.7 vs 0%) [73]. Confusion [87] and flexion contracture [86,88] may occur in people with PD post-TKA. Survival at 1-year post-TKA is similar between people with PD and those who do not have PD [82]; however, mortality rates, when measured between 2 and 10 years post-TKA, appear to be higher for people with PD compared with age-matched controls [73,82,86]. ...
The prevalence of musculoskeletal (MSK) pain in people with Parkinson disease (PD) is higher than that of age-matched controls. In this review, we outline what is known about MSK pain in PD, focusing on the neck, shoulder, knee, hip and low back. We also compare what is known about MSK pain in PD to what is known in older adults without PD. Finally, we outline areas of for future research related to MSK pain in people with PD.
Acute postoperative posterior total knee arthroplasty (TKA) dislocation is rare in primary surgery but has been associated with Parkinson’s disease (PD). We present a 77-year-old woman with knee arthritis and PD who sustained an acute, recurrent TKA posterior dislocation, recalcitrant to polyethylene upsizing. Transient stability was obtained for a period of 1 year after postoperative hamstring injection with botulinum toxin A and short-term immobilization. Spontaneous instability recurred after 1 year, and stability was obtained with revision to a more constrained construct and has been monitored over a period of 2 years. This is the first report demonstrating the use of botulinum toxin A for acute posterior TKA instability associated with PD. We endorse the necessity of increased constraint to maintain long-term stability in patients with Parkinson’s disease.
Introduction:
Thanks to improvements in the medical treatment of Parkinson's disease (PD), the life expectancy of these patients has increased, but the overall outcome after total knee arthroplasty (TKA) is controversial. We aim to analyse a series of patients with PD, evaluating their clinical status, functional results, complications and survival rates after TKA.
Methods:
We retrospectively studied 31 patients with PD operated between 2014 and 2020. The mean age was 71 years (SD±5.8). There were 16 female patients. The mean follow-up was 68.2 months (SD±36). We used the knee scoring system (KSS) and the visual analogue scale (VAS) for the functional evaluation. The modified Hoehn and Yahr scale was used to assess the severity of PD. All complications were recorded, and survival curves were performed.
Results:
The mean postoperative KSS evaluation had an increase of 40 points [35 (SD±15) vs 75 (SD±15) (p<.001)]. The mean postoperative VAS decreased 5 points [8 (SD±2) vs 3 (SD±2) (p<.001)]. Thirteen patients reported being very satisfied, 13 were satisfied, and only 5 were poorly satisfied. Seven patients suffered surgical complications, and 4 patients had recurrent patellar instability. At a mean 68.2 months follow-up, the overall survival rate was 93.5%. When considering the secondary patellar resurfacing as the endpoint, the survival rate was 80.6%.
Conclusions:
In this study, TKA was associated with excellent functional outcomes in patients with PD. At a mean 68.2 months follow-up, TKA had excellent survivorship in the short term, with recurrent patellar instability as the most common complication. Even though these findings confirm the effectiveness of TKA in this population, a thorough clinical evaluation and multidisciplinary approach are needed to decrease the likelihood of complications.
Introduction:
Thanks to improvements in the medical treatment of Parkinson's disease (PD), the life expectancy of these patients has increased, but the overall outcome after total knee arthroplasty (TKA) is controversial. We aim to analyse a series of patients with PD, evaluating their clinical status, functional results, complications and survival rates after TKA.
Methods:
We retrospectively studied 31 patients with PD operated between 2014-2020. The mean age was 71 years (SD±5.8). There were 16 female patients. The mean follow-up was 68.2 months (SD±36). We used the Knee Scoring System (KSS) and the Visual Analog Scale (VAS) for the functional evaluation. The Modified Hoehn and Yahr Scale was used to assess the severity of PD. All complications were recorded, and survival curves were performed.
Results:
The mean postoperative KSS evaluation had an increase of 40 points [35 (SD±15) vs 75 (SD±15) (p<0.001)]. The mean postoperative VAS decreased 5 points [8 (SD±2) vs 3 (SD±2) (p<0.001)]. Thirteen patients reported being very satisfied, 13 were satisfied, and only five were poorly satisfied. Seven patients suffered surgical complications, and four patients had recurrent patellar instability. At a mean 68.2 months follow-up, the overall survival rate was 93.5%. When considering the secondary patellar resurfacing as the endpoint, the survival rate was 80.6%.
Conclusions:
In this study, TKA was associated with excellent functional outcomes in patients with PD. At a mean 68.2 months follow-up, TKA had excellent survivorship in the short term, with recurrent patellar instability as the most common complication. Even though these findings confirm the effectiveness of TKA in this population, a thorough clinical evaluation and multidisciplinary approach are needed to decrease the likelihood of complications.
Objective To explore the effects of different-intensity intermediate frequency therapy on functional recovery of patients with knee osteoarthritis.
Methods Three-band electromagnetic waves of constant amplitude intermediate frequency electrotherapy group (Group A), interference electrotherapy group (Group B) and modulated intermediate frequency electrotherapy group (Group C) were used to treat knee osteoarthritis (KOA) patients, 20 min/time, 1 time/day and 5 days/week for four weeks. Other rehabilitation items were performed the same way. The rehabilitation therapy were evaluated by VAS score, Timed Up and Go test and balance ability.
Results After 4 weeks of treatment, the treatment effects of the three groups were all significant compared with the pre-treatment. Among the three groups, the treatment effect of Group B was better than that of the other two groups, and there was no significant difference in the treatment effect between Group A and Group C.
Conclusion According to thee. g.results, it is possible that the interference current is of a great action depth, and the "endogenous" low-frequency modulated intermediate frequency current possesses the advantages of both low and intermediate frequency, so with the intermediate frequency current getting through the high resistance of skin, the current effect of the low and intermediate frequency in the deep part of the human body can be achieved.
Background
The number of Parkinson’s patients (PD) undergoing total knee arthroplasty (TKA) is increasing. The purpose of the study was to characterize quality of life (QOL) outcomes for patients with coexisting PD and knee osteoarthritis (KOA) following TKA.
Methods
Patients with coexisting PD and KOA undergoing TKA between June 2014 and June 2020 were included. These patients were matched to controls with KOA alone by age, gender, basic social background information and Knee society score (KSS). The primary measure was to assess the QOL by the absolute changes in the EuroQOL5-Dimensions (EQ-5D), Pain and Disability Questionnaire (PDQ), and Patient Health Questionnaire-9(PHQ-9) at the last follow-up (LFU). Secondary measures were changes in QOL that exceeded the minimum clinically important difference value (MCID). Data on the health status and QOL of all patients were collected. Simple and multivariate regression analysis was used to evaluate the impact of PD on their QOL.
Results
Twelve KOA patients with PD were compared with 48 controls. Control patients experienced QOL improvement across all three measures:EQ-5D index (0.545–0.717, P < 0.01), PDQ (81.1–52.3, P < 0.01) and PHQ-9(8.22–5.91, P < 0.01) were significantly improved at the LFU; while in patients with PD, only PDQ (91.0–81.4, P = 0.03) slightly improved. There were significant differences in the improvement of QOL between PD patients and the control group through EQ-5D (0.531 vs.0.717, P < 0.01) and PDQ (81.4vs.52.3, P < 0.01) at the LFU.
Conclusion
TKA has no benefit of QOL beyond a slight improvement in pain-related disability in the KOA patients with PD.
