Outcomes of Primary Total Knee Arthroplasty in Patients With Parkinson's Disease

Abstract

Background: Parkinson's disease is a degenerative disorder causing rigidity, bradykinesia, and tremor of the motor system. There is significant paucity of evidence regarding whether total knee arthroplasty (TKA) is of benefit in patients with both Parkinson's disease and osteoarthritis. We aimed to compare outcomes and complications of TKA between patients with Parkinson's disease and those without.

Methods: A cohort of 43 knees from 35 patients with Parkinson's disease who received a primary TKA between January 2004 and December 2015 were retrospectively extracted from a private clinical database held by 2 surgeons and compared to an age and gender-matched control group of 50 knees from 41 patients. TKAs were performed by 2 surgeons at 1 tertiary private hospital.The indication for TKA in both groups was osteoarthritis. Difference between preoperative and 1-year range of movement (ROM) and 12-point Oxford Knee Score (OKS) was assessed using Student's unpaired t-test. Postoperative complications and revision procedures were also recorded during the follow-up period. The minimal clinically important difference for OKS at 1-year follow-up, defined as improvement of ≥6, was also assessed.

Results: In the Parkinson's group, mean ROM improvement was 14° (100° preoperatively to 114° at 12 months), compared to 12° in the control group (102°-114°, respectively). Mean OKS improvement was 15 in the Parkinson's group (23 preoperatively to 38 at 12 months) compared to 17 in the control group (23 and 40, respectively.) No significant difference was identified between the 2 groups for either ROM (P = .96) or OKS (P = .45.) All Parkinson's patients achieved the minimal clinically important difference at 1-year follow-up. There were no mortalities during the study follow-up period and no significant difference in complication rates between the 2 groups (P = .41).

Conclusion: Parkinson's disease was not associated with poorer functional outcomes or increased complications compared to controls in our study. We suggest that Parkinson's disease is not an absolute contraindication to TKA.

Keywords: Parkinson's; arthroplasty; knee; osteoarthritis; outcomes; total.