Archives of Orthopaedic and Trauma Surgery Do we really improve life quality after total knee arthroplasty in patients with Parkinson's disease?

Abstract

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 knees) with osteoarthritis who underwent a TKA between 1994 and 2013. Comorbidities, anesthetic procedures and complications were recorded. Patient functional status was assessed with the Knee Society Function Score (KFS) and the Knee Society Score (KSS). PD stage was classified with the Hoehn and Yahr Scale.

Results
The mean follow-up was 3.5 years (range 2–9). The mean age was 71 years (range 61–83) with a mean time since PD diagnosis of 11.8 years (range 4–24). PD severity on the Hoehn and Yahr Scale was 1.5 points before surgery and 2 points postoperatively. Pain on the visual analogic scale improved from 8 points preoperatively to 5 points at 1-year follow-up; 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 KFS, respectively. The mean postoperative hospital stay was 9.8 days (range 5–21). Confusion and flexion contracture were the most frequent perioperative complications.

Conclusion
TKA successfully provided pain relief in PD patients. However, the functional outcome is related to disease progression and, therefore, variable. Perioperative complications are difficult to avoid and manage.

Full text

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Archives of Orthopaedic and Trauma Surgery (2021) 141:313–319
https://doi.org/10.1007/s00402-020-03644-8
KNEE ARTHROPLASTY
Do we really improve life quality aftertotal knee arthroplasty
inpatients withParkinson’s disease?
VerónicaMontielTerrón1 · MaríaVitoria1· JoseMaríaLamodeEspinosaVázquezdeSola1·
JuanRamónValentíNin1· AndrésValentíAzcárate1
Received: 18 April 2020 / Accepted: 15 October 2020 / Published online: 9 November 2020
© Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract
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 knees) with osteoarthritis who underwent a TKA
between 1994 and 2013. Comorbidities, anesthetic procedures and complications were recorded. Patient functional status
was assessed with the Knee Society Function Score (KFS) and the Knee Society Score (KSS). PD stage was classified with
the Hoehn and Yahr Scale.
Results The mean follow-up was 3.5years (range 2–9). The mean age was 71years (range 61–83) with a mean time since PD
diagnosis of 11.8years (range 4–24). PD severity on the Hoehn and Yahr Scale was 1.5 points before surgery and 2 points
postoperatively. Pain on the visual analogic scale improved from 8 points preoperatively to 5 points at 1-year follow-up;
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 KFS, respectively. The mean postoperative hospital stay was 9.8days (range 5–21). Confusion and flexion contracture
were the most frequent perioperative complications.
Conclusion TKA successfully provided pain relief in PD patients. However, the functional outcome is related to disease
progression and, therefore, variable. Perioperative complications are difficult to avoid and manage.
Keywords Parkinson’s disease· Total knee arthroplasty· Osteoarthritis· Functional assessment
Introduction
Parkinson’s disease (PD) is a progressive neurodegenerative
disorder and a relatively common geriatric problem, clini-
cally characterized by the progressive impairment of several
motor and non-motor neurological functions [1]. The loss of
pigmented dopaminergic neurons may cause various motor
symptoms such as rigidity, or bradykinesia among others.
When these patients develop degenerative joint disease in
addition to their neurological condition, mobility becomes a
relevant problem for them [2, 3]. The rigidity secondary PD
often aggravates the severe and debilitating pain caused by
osteoarthritis. This pain and the postural instability increase
the risk of falls and are important determinants of the patient’s
quality of life [4]. Levodopa is the gold standard treatment
used to palliate the motor symptoms. Surgical procedures such
as pallidotomy, subthalamotomy or high-frequency deep-brain
stimulation (DBS) are available for the management of unre-
lenting cases of PD [5, 6]. Despite treatment, several studies
have demonstrated that the motor symptoms have a nonlin-
ear progression pattern over the course of the disease. The
progression is faster in patients in early stages of the disease
(Hoehn and Yahr stages 1–2.5) than in patients with longer
courses of the disease (in stages 3–5) [7, 8].
The increased life expectancy resulting from improved
medical management of patients with PD suggests that the
number of these patients requiring a total knee arthroplasty
(TKA) will probably increase in the future [9]. TKA designs
have shown excellent short- and long-term clinical results and
survival rates in patients with osteoarthritis and rheumatoid
* Verónica Montiel Terrón
vmontiel@unav.es
1 Orthopedic Surgery andTraumatology Department, Clínica
Universidad de Navarra, Av. Pio XII, 36, 31008Pamplona,
Spain
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