Article 10: Outcomes of THR in Patients with PD: Comparison of Elective and Hip Fx Groups

Intro:

• Prevalence of PD and the incidence of hip fractures mirror WHAT?

• PD patients with hip fractures stay at higher risk of WHAT 2 THINGS?

• WHAT is one of the highly efficient surgical techniques leading to improvement in pt QOL. 

• Aging Population Living Longer

• Mortality and Surgical/Medical Complications

• Contemporary THA

Purpose:

• The aim of this article was to:

  • Compare short to WHAT following elective and traumatic total hip arthroplasty in patients with PD focusing on the assessment of risk and benefits of sx

• Mid term clinical outcomes

Materials and Methods:

• Primary indication of surgery was OA of 10 Hips =

• THA from Proximal Femoral Fx =

• Elective Group

• Hip Fx Group

Methods and Materials:

• What are the 3 main Outcome Measures used in this study?

• Charnley’s Modified Merele d’Aubigne and Postel Scoring System 

  • Composite score including objective clinical parameters DIFFERENT FROM PAIN 

• Pain score component of Charnley’s Modified Merele d’Aubigne and Postel Scoring System

• PD = Hoehn and Yahr

Methods and Materials:

• Functional status was based on assessment of independent ability to ____

  • What are the 2 distinguishing factors considered?

• Walk

• 2:

  • Maintained independent ability to walk; being able to walk without support from another person (with aids if necessary)

  • Not maintained: support from another person or use of a WC required

Results:

• Statistically significant difference between the medias of Charnley’s Modified Merle d’Aubigne and Postel Scoring System in the elective and hip fracture group was recorded WHEN?

• WAS THERE ANY STATISTICALLY SIGNIFICANTt difference between the two groups during follow up. 

• POSToperatively at 6 and 36 months after THA

• NAUR

Results:

• Improvement in Charnley’s Modified Merele d’Aubigne and Postel Scoring System WHEN was statistically significant

• Elective group had _____ significantly higher PAIN score when compared to the hip fx group 

• PREoperatively to 6 months POSToperatively

• POSToperatively

Results:

• Improvement in pain score WHEN was significantly significant for both groups 

• Despite the improvements in Charnley’s Modified Merele d’Aubigne and Postel Scoring System and Pain scores, disability related to PD _____ during the follow up 

• ____ complications were observed in BOTH groups, the medical complications were seen mainly in pts undergoing WHAT. 

• PREoperatively to 6 months POSToperatively

• Increased

• Surgical, THA for femorall fx

Discussion:

• Improvement was maintained from WHEN to WHEN in the elective and hip fracture group. 

• Pts in Elective group benefited from WHAT and were able to walk w/o support of another person at ___ months after THA

• 6 months after sx to latest follow up

• Excellent pain relief; 36 months

Discussion: UTI

• What was the most frequently recorded medical complication?

• Overactivity of what is common in PD pts?

• What plays an important role in development of UTI?

• UTI

• Neurogenic Detrusor

• Bladder Dysfunction

Discussion: Obstructive Resp Pattern

• Obstructive Resp Pattern is due to Neuromuscular Dysfunction that predisposes what 3 things?

• What occurs in 29% of PD pts w Femoral Fx?

• High __ __ rates

• 3:

  • Retained Secretion

  • Atelectasis

  • Pulmonary Infection Rates

• PNA

• Pulmonary Infection

Discussion:

• High rates of ___ ___ were published in the PD pts after hip fx

Pressure Sores

Discussion: MSK Manifestation

• MSK Manifestations of PD includes what 6 symptoms?

  • These symptoms predisposes pt to what?

• _ __is an important finding in these patients can be overlooked during the procedure

• 6

  • Tremor

  • Rigidity

  • Contractors

  • Bradykinesia

  • Dystonia

  • Postural Instability

• Dislocation of the Hip

• Adduction Contracture

Discussion: Falls

• PD pts experience falls as a result of WHAT and many have WHAT

• __ in pts with PD experience at least one episode 

• __ have recurrent falls 

• High frequency of falls consequently contributes to the increased __ __

• Disease Symptoms; Recurrent Episodes

• 60.5%

• 39%

• Fx Risk

Conclusion:

• THA in pts with PD is challenging d/t WHAT seen in pts with Hip Fx

•  Excellent pain relief with preserved walking ability without support of another person and acceptable complications in pts with PD at ___ months after elective THA. 

• __ __ may be indicated in pts with PD after careful and individualized planning 

• Higher Risk of medical Complications

• 36 Months

• Elective THA

Quiz Question:

What was the most frequently recorded medical complication found in the population of PD patients with a hip fracture? 

1. Radiculopathy 

2. Fecal Incontinence 

3. Infection 

4. Urinary Tract Infection 

UTI

Quiz Question:

Which of the following is not a musculoskeletal manifestation of PD that predisposes individuals to hip dislocations?

1. Hip Dysplasia 

2. Rigidity 

3. Postural Instability 

4. Contractures 

Hip Dysplasia

Quiz Question:

Which of the following best reflects the clinical interpretation of revision and mortality risk in patients with Parkinson’s disease following surgery?

1. Patients with Parkinson’s disease are at increased risk of both revision surgery and mortality within the first 90 days postoperatively.

2. Although short-term outcomes are favorable, patients with Parkinson’s disease demonstrate a delayed increase in revision surgery risk beginning at 1 year postoperatively.

3. Increased revision risk in Parkinson’s disease occurs early in the postoperative period but stabilizes after the first year, aligning with the general population.

4. The absence of short-term revision risk suggests that long-term orthopedic follow-up is not necessary for patients with Parkinson’s disease after surgery.

1. Although short-term outcomes are favorable, patients with Parkinson’s disease demonstrate a delayed increase in revision surgery risk beginning at 1 year postoperatively.

Quiz Question:

True or False: PD patients are 2-3 times more likely to suffer a hip fracture compared to the general population. 

True/False

True

Quiz Question:

Based on research comparing hip fracture outcomes, how do patients with Parkinson’s disease differ from non-Parkinson’s patients in terms of hospital stay and discharge disposition?

1. They have comparable hospital lengths of stay but are often discharged to skilled nursing facilities due to poor functional independence.

2. They experience shorter hospital stays but require more extensive outpatient therapy after discharge.

3. They tend to have longer hospital stays and are more frequently discharged to skilled nursing facilities.

4. Their hospital length of stay and discharge patterns do not significantly differ from those of non-Parkinson’s patients, indicating similar recovery trajectories.

1. They tend to have longer hospital stays and are more frequently discharged to skilled nursing facilities.

Quiz Question:

Which of the following intraoperative findings is often overlooked in patients with Parkinson’s disease?

1. Abduction lag 

2. Adduction contracture 

3. Knee hyperextension 

4. Ankle plantarflexion weakness

1. Adduction contracture 

Quiz Question:

An 82-year-old woman with a 5-year history of Parkinson’s disease presents to the emergency department after a fall at home. Imaging reveals a displaced femoral neck fracture. She is moderately impaired in her functional mobility and lives with some assistance. Her cognitive status shows mild impairment. Her family asks about surgical options and prognosis. 

 Based on the patient’s condition and current evidence regarding neurodegenerative diseases  (discussed in the readings), which surgical intervention is most appropriate for this patient?

1. Total hip arthroplasty (THA) 

2. Hemiarthroplasty 

3. Open reduction and internal fixation (ORIF) 

4. Conservative (non-surgical) management 

1. Hemiarthroplasty 

Quiz Question:

An 82-year-old woman with a 5-year history of Parkinson’s disease presents to the emergency department after a fall at home. Imaging reveals a displaced femoral neck fracture. She is moderately impaired in her functional mobility and lives with some assistance. Her cognitive status shows mild impairment. Her family asks about surgical options and prognosis. 

Considering the impact of Parkinson’s disease progression on postoperative outcomes (discussed in the readings), which factor most strongly influences the choice of surgical treatment for hip fractures in this population?

1. The patient’s cognitive status and ability to participate in rehabilitation 

2. The potential for complete recovery of pre-fracture functional status 

3. The likelihood of long-term implant survival without revision surgery 

4. The severity of pre-existing osteoarthritis in the hip joint 

1. The patient’s cognitive status and ability to participate in rehabilitation