In the first national-scale study on complication rates amongst patients with Parkinson’s disease undergoing total knee arthroplasty (TKA), researchers found that these patients experienced longer hospital stays but that their outcomes were comparable to patients without Parkinson’s disease.
Parkinson’s Patients Fare Well After TKA – New Study
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The study, “Matched cohort analysis of peri-operative outcomes following total knee arthroplasty in patients with and without Parkinson’s disease,” was published in the August 2019 edition of The Knee.
Alan Daniels, M.D., with the Department of Orthopaedic Surgery at Brown University in Providence, Rhode Island, explained the purpose of this study to OTW, “This study sought to examine outcomes from total knee arthroplasty patients with Parkinson’s disease.”
“Parkinson’s patients have traditionally been thought to have poor clinical outcomes, however, careful statistical matching between those with and without Parkinson’s evaluating short-term outcomes has not previously been performed.”
The team matched Parkinson’s patients 1:10 with non-Parkinson’s patients for age, sex, Charlson Comorbidity Index (CCI), and year of admission.
The authors used data from the Healthcare Cost and Utilization Project from 2000 to 2012 and found that in the matched cohort, patients with Parkinson’s disease experienced an increased hospital length of stay (3.92 vs 3.71 days) and were charged correspondingly more for their stay ($41,523.52 vs $40,657.00).
Importantly, however, the research team found that there was NO significant difference in in-hospital complication rate (8.28% vs 8.04%) or in-hospital mortality (0.164% vs 0.150%) between patients with Parkinson’s disease patients and matched patients without Parkinson’s disease.
Dr. Daniels elaborated on the study results for OTW, “Patients with Parkinson’s are a unique patient population requiring multidisciplinary care. Although length of stay and complications are longer in Parkinson’s patients following knee arthroplasty, outcomes may still be acceptable. Parkinson’s patients, when carefully assessed, optimized, and managed may enjoy great benefit from knee replacement.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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