Journal: Journal of Shoulder and Elbow Surgery
Who: Harold G. Moore, BS; Joseph B. Kahan, MD, MPH; Josiah J. Z. Sherman BS; Patrick J. Burroughs, MD; Kenneth W. Donohue, MD; Jonathan N. Grauer, MD
Overview: Patients with Parkinson’s disease and shoulder osteoarthritis may be indicated for total shoulder arthroplasty. However, short- and long-term outcomes after total shoulder arthroplasty in this population remain poorly characterized.
A retrospective matched case-control study was performed using data abstracted from the 2010-2018 PearlDiver Mariner administrative database. Patients undergoing total shoulder arthroplasty were identified and those with and without the diagnosis of Parkinson’s disease were matched (1:10) based on age, gender, Elixhauser comorbidity index, diabetes, chronic kidney disease, obesity, coronary artery disease, and congestive heart failure. Ninety-day incidence of adverse events were compared with multivariate regressions. Implant survival was also assessed for up to five years, based on occurrence of revision surgery. Kaplan Meier implant survival curves were compared using a log-rank test.
In total, 478 patients with Parkinson’s disease were matched to 4,715 patients without Parkinson’s disease. After adjusting for demographic and comorbid factors, patients with Parkinson’s disease had significantly higher odds of prosthetic dislocation (Odds Ratio = 3.07, p=0.001), but did not experience increased odds of other 90-day adverse events. Five-year follow-up was available for 428 (89.5%) of those with Parkinson’s disease and 3,794 (80.5%) of those without Parkinson’s disease. There was 97.2% implant survival of the Parkinson’s disease cohort and 97.7% implant survival in the matched control cohort (not significantly different, p=0.463).
Patients with Parkinson’s disease undergoing total shoulder arthroplasty, compared to patients without Parkinson’s disease, have three-fold higher odds of periprosthetic dislocation in the 90-day postoperative period, but equivalent rates of other short-term adverse events as well as implant survival at 5 years. Accordingly, surgeons should be mindful of the short-term risk of implant instability but should have confidence in long-term total shoulder implant success in the Parkinson’s disease population.