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Call CM, McGrory BJ, Thompson EA, Sommer LG, Savadove TS. Treatment of Postoperative Instability Following Total Knee Arthroplasty in Patients With Parkinson's Disease. Arthroplast Today 2024; 25:101273. [PMID: 38229869 PMCID: PMC10790002 DOI: 10.1016/j.artd.2023.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/27/2023] [Accepted: 10/19/2023] [Indexed: 01/18/2024] Open
Abstract
Acute postoperative posterior total knee arthroplasty (TKA) dislocation is rare in primary surgery but has been associated with Parkinson's disease (PD). We present a 77-year-old woman with knee arthritis and PD who sustained an acute, recurrent TKA posterior dislocation, recalcitrant to polyethylene upsizing. Transient stability was obtained for a period of 1 year after postoperative hamstring injection with botulinum toxin A and short-term immobilization. Spontaneous instability recurred after 1 year, and stability was obtained with revision to a more constrained construct and has been monitored over a period of 2 years. This is the first report demonstrating the use of botulinum toxin A for acute posterior TKA instability associated with PD. We endorse the necessity of increased constraint to maintain long-term stability in patients with Parkinson's disease.
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Affiliation(s)
- Catherine M. Call
- Tufts University School of Medicine, Boston, MA, USA
- Division of Joint Replacement Surgery, Maine Medical Center, Portland, ME, USA
| | - Brian J. McGrory
- Tufts University School of Medicine, Boston, MA, USA
- Division of Joint Replacement Surgery, Maine Medical Center, Portland, ME, USA
| | - Erica A. Thompson
- Department of Rehabilitation, Maine Medical Center, Portland, ME, USA
| | - Lydia G. Sommer
- Department of Rehabilitation, Maine Medical Center, Portland, ME, USA
| | - Thomas S. Savadove
- Department of Physical Medicine and Rehabilitation, Maine Medical Center, Portland, ME, USA
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Gault JM, Hosokawa P, Kramer D, Saks ER, Appelbaum PS, Thompson JA, Olincy A, Cascella N, Sawa A, Goodman W, Moukaddam N, Sheth SA, Anderson WS, Davis RA. Postsurgical morbidity and mortality favorably informs deep brain stimulation for new indications including schizophrenia and schizoaffective disorder. Front Surg 2023; 10:958452. [PMID: 37066004 PMCID: PMC10098000 DOI: 10.3389/fsurg.2023.958452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Background Deep brain stimulation (DBS) shows promise for new indications like treatment-refractory schizophrenia in early clinical trials. In the first DBS clinical trial for treatment refractory schizophrenia, despite promising results in treating psychosis, one of the eight subjects experienced both a symptomatic hemorrhage and an infection requiring device removal. Now, ethical concerns about higher surgical risk in schizophrenia/schizoaffective disorder (SZ/SAD) are impacting clinical trial progress. However, insufficient cases preclude conclusions regarding DBS risk in SZ/SAD. Therefore, we directly compare adverse surgical outcomes for all surgical procedures between SZ/SAD and Parkinson's disease (PD) cases to infer relative surgical risk relevant to gauging DBS risks in subjects with SZ/SAD. Design In the primary analysis, we used browser-based statistical analysis software, TriNetX Live (trinetx.com TriNetX LLC, Cambridge, MA), for Measures of Association using the Z-test. Postsurgical morbidity and mortality after matching for ethnicity, over 39 risk factors, and 19 CPT 1003143 coded surgical procedures from over 35,000 electronic medical records, over 19 years, from 48 United States health care organizations (HCOs) through the TriNetX Research Network™. TriNetXis a global, federated, web-based health research network providing access and statistical analysis of aggregate counts of deidentified EMR data. Diagnoses were based on ICD-10 codes. In the final analysis, logistic regression was used to determine relative frequencies of outcomes among 21 diagnostic groups/cohorts being treated with or considered for DBS and 3 control cohorts. Results Postsurgical mortality was 1.01-4.11% lower in SZ/SAD compared to the matched PD cohort at 1 month and 1 year after any surgery, while morbidity was 1.91-2.73% higher and associated with postsurgical noncompliance with medical treatment. Hemorrhages and infections were not increased. Across the 21 cohorts compared, PD and SZ/SAD were among eight cohorts with fewer surgeries, nine cohorts with higher postsurgical morbidity, and fifteen cohorts within the control-group range for 1-month postsurgical mortality. Conclusions Given that the subjects with SZ or SAD, along with most other diagnostic groups examined, had lower postsurgical mortality than PD subjects, it is reasonable to apply existing ethical and clinical guidelines to identify appropriate surgical candidates for inclusion of these patient populations in DBS clinical trials.
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Affiliation(s)
- Judith M. Gault
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Correspondence: Judith M. Gault
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elyn R. Saks
- The Law School, University of Southern California, Los Angeles, CA, United States
| | - Paul S. Appelbaum
- Department of Psychiatry, Columbia University, New York, Ny, United States Of America
| | - John A. Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ann Olincy
- VA Eastern Colorado Medical Center, Aurora, CO, United States
| | - Nicola Cascella
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Akira Sawa
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Wayne Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Nidal Moukaddam
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - William S. Anderson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel A. Davis
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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A commentary on “Effect of Parkinson's disease on primary total joint arthroplasty outcomes: A meta-analysis of matched control studies” (Int J Surg 2019;71:124-31). Int J Surg 2022; 102:106669. [DOI: 10.1016/j.ijsu.2022.106669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/10/2022] [Indexed: 11/19/2022]
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Acuña AJ, Courtney PM, Kurtz SM, Lee GC, Kamath AF. Spine Fusions, Yoga Instructors, and Hip Fractures: The Role of Dual Mobility in Primary Total Hip Arthroplasty. J Arthroplasty 2021; 36:S70-S79. [PMID: 33516631 DOI: 10.1016/j.arth.2020.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the increased use of dual mobility (DM) in primary total hip arthroplasty (THA), debate exists regarding the indications for its use. No specific algorithm exists to guide this decision-making process. Therefore, the purpose of this article is to summarize the currently available literature regarding the use of DM in primary THA and provide evidence-based guidelines based on specific patient populations and risk factors for instability. METHODS We reviewed the current literature for studies evaluating risk factors for dislocation in primary THA, as well as the clinical use and results of DM in primary THA. Based on the strength of the literature, we discuss the use of DM in specific patient populations. We provide a decision-making algorithm to determine whether a patient may be indicated for DM in primary THA. RESULTS Surgeons should consider preoperative patient demographics, risk factors for instability (eg, significant hip-spine issues), type of procedure to be performed (eg, conversion arthroplasty), and indications for surgery (eg, THA for femoral neck fracture). Based on this algorithmic assessment, DM may be warranted in the primary THA setting if a patient's combined risk reaches an established threshold based on the literature. CONCLUSION This evidence-based algorithm may help guide current practice in the use of DM in primary THA. We advocate the continued judicious use of DM in hip arthroplasty. Longer term studies are needed in order to evaluate the durability of DM, as well as any complications related to the DM articulation.
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Affiliation(s)
- Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - P Maxwell Courtney
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Steven M Kurtz
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania; Biomedical Engineering Practice, Exponent Inc, Menlo Park, California
| | - Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Penn Musculoskeletal Center, Philadelphia, Pennsylvania
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Kawabata A, Yoshii T, Sakai K, Hirai T, Yuasa M, Inose H, Matsukura Y, Morishita S, Tomori M, Torigoe I, Kusano K, Otani K, Arai Y, Shindo S, Okawa A. Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson's disease: a multi-institutional retrospective cohort study. BMC Musculoskelet Disord 2021; 22:357. [PMID: 33863320 PMCID: PMC8051124 DOI: 10.1186/s12891-021-04233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Parkinson’s disease (PD) has been found to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, few studies have investigated this by directly comparing patients with PD and those without PD. Methods In this multicenter retrospective cohort study, we reviewed all surgically treated ASD patients with at least 2 years of follow-up. Among them, 27 had PD (PD+ group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients. Results For early complications, the PD+ group demonstrated a higher rate of delirium than the PD− group. In terms of late complications, the rate of non-union was significantly higher in the PD+ group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD+ group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD+ group. Conclusion Extra attention should be paid to perioperative complications, especially delirium, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of non-union were greater in these patients.
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Affiliation(s)
- Atsuyuki Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan.
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Kazuo Kusano
- Department of Orthopedic Surgery, Kudanzaka Hospital, 1 Chome-6-12 Kudanminami, Chiyoda, Tokyo, 102-0074, Japan
| | - Kazuyuki Otani
- Department of Orthopedic Surgery, Kudanzaka Hospital, 1 Chome-6-12 Kudanminami, Chiyoda, Tokyo, 102-0074, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Shigeo Shindo
- Department of Orthopedic Surgery, Kudanzaka Hospital, 1 Chome-6-12 Kudanminami, Chiyoda, Tokyo, 102-0074, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan
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Min H, Li Y. Response to the commentary on "Effect of Parkinson's Disease on Primary Total Joint Arthroplasty Outcomes: A Meta-Analysis of Matched Control Studies" (published in Int J Surg 2019;72:78). Int J Surg 2020; 74:92-93. [PMID: 31935450 DOI: 10.1016/j.ijsu.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Huan Min
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, 92 Aiguo Road, Nanchang, 330006, Jiangxi, China
| | - Yuxu Li
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, 92 Aiguo Road, Nanchang, 330006, Jiangxi, China.
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Li L, Li S, Zhu T. A commentary on "Effect of Parkinson's disease on primary total joint arthroplasty outcomes: A meta-analysis of matched control studies" (Int J Surg 2019;71:124-31). Int J Surg 2019; 73:26-27. [PMID: 31783163 DOI: 10.1016/j.ijsu.2019.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Linji Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; Department of Anesthesiology, The Second Clinical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Shunhong Li
- Department of Anesthesiology, The Second Clinical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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Zhao S, Zhu Y, Ruan Z. A commentary on "Effect of Parkinson's disease on primary total joint arthroplasty outcomes: A meta-analysis of matched control studies" (Int J Surg 2019, Epub ahead of print). Int J Surg 2019; 72:194-195. [PMID: 31704422 DOI: 10.1016/j.ijsu.2019.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Shushan Zhao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Yong Zhu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Zhe Ruan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China.
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Tao Q, Ming J, Lan Y. A commentary on "Effect of Parkinson's disease on primary total joint arthroplasty outcomes: A meta-analysis of matched control studies" (Int J Surg 2019; Sep 26;71:124-131. doi: 10.1016/j.ijsu.2019.09.013). Int J Surg 2019; 72:78. [PMID: 31683042 DOI: 10.1016/j.ijsu.2019.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Qifeng Tao
- Department of Orthopaedics, Panzhihua Municipal Central Hospital, Panzhihua, 34# Yikang Street, 617067, PR China.
| | - Jie Ming
- Department of Orthopaedics, Panzhihua Municipal Central Hospital, Panzhihua, 34# Yikang Street, 617067, PR China.
| | - Yuping Lan
- Department of Orthopaedics, Panzhihua Municipal Central Hospital, Panzhihua, 34# Yikang Street, 617067, PR China.
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