Knee replacement surgery safe for Parkinson’s disease patients

Movement disorders

By Mardi Chapman

19 Jul 2018

Total knee arthroplasty for the management of osteoarthritis is as safe and effective in patients with Parkinson’s disease as it is in the general population.

According to new Australian research, clinical outcomes were similar when comparing a series of 43 knees from 35 patients with Parkinson’s disease and 50 knees from 41 age and gender matched controls without Parkinson’s disease.

The study found no significant difference in final postoperative Oxford Knee Scores (OKS) or in the change from preoperative scores to that at 12 months post-op.

Similarly there was no significant difference between the groups in postoperative range of motion (ROM) or the improvement in range of movement between baseline and 12 months post-op.

Complication rates including DVT were also statistically similar in both groups with no revisions in either group and no mortality.

“Based on the findings of our study, we conclude that TKA provides comparable outcomes with regard to ROM and OKSs in patients with Parkinson’s disease who are also suffering from severe OA,” the study concluded.

“Furthermore, TKA is a safe procedure with acceptable complication rate in this subgroup of patients. Patients with Parkinson’s disease should be given the same consideration for TKA as the general population.”

Dr David Parker, an orthopaedic surgeon at Royal North Shore Hospital and the Sydney Orthopaedic Research Institute told the limbic that concerns about knee replacement in people with Parkinson’s disease were largely historical.

“With modern techniques and a little bit of insight into their condition, I think we can get just as good a result.”

“And often, because these are patients who don’t have huge expectations – they aren’t trying to get back to playing sports for example – they can be even more satisfied because they have had such good relief of pain.”

He said the same criteria and principles of knee replacement and postoperative rehabilitation applied.

“You don’t expect them to perform as rapidly as someone without Parkinson’s but their relative improvement will be the same.”

He said the main considerations for patients being treated with deep brain stimulation was they had their device switched off before the surgery and that bipolar diathermy was used to avoid any thermal injury.

Patients with Parkinson’s disease should continue to take their usual medications.

“Any orthopaedic surgeon treating someone with Parkinson’s should communicate with the neurologist that they are planning surgery and find out any extra precautions or extra measures that the neurologist would like to take for their patients.”

“Otherwise they should be treated like any other patients with knee osteoarthritis. They should be given the same access and consideration for knee replacement surgery and they should be able to get equivalent outcomes.”

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