Fontalis Andreas, Kenanidis Eustathios, Bennett-Brown Katharine, Tsiridis Eleftherios
Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, UK.
Academic Unit of Bone Metabolism, University of Sheffield Medical School, Sheffield, UK.
EFORT Open Rev. 2020 Dec 4;5(12):856-865. doi: 10.1302/2058-5241.5.200034. eCollection 2020 Dec.
Parkinson's disease (PD) poses a significant challenge for the arthroplasty surgeon, owing to excessive muscle tone, higher fracture risk and poor bone quality. Several studies have reported high mortality, early failure and perioperative complications associated with hip fracture surgery in PD; however, no higher-level evidence exists regarding elective hip arthroplasty.The aim of our study was to perform a systematic review to evaluate the evidence basis and clinical outcomes pertaining to patients with underlying Parkinson's disease undergoing elective total hip arthroplasty (THA).We searched MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials to identify studies evaluating the safety and clinical outcomes of THA in patients suffering from Parkinson's. Our review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Ten studies encompassing 49,730 patients were included in our systematic review. Qualitative synthesis demonstrated comparable results between PD patients and controls with respect to one-year mortality and surgical site infections. PD patients experienced more medical complications, had a longer hospital stay and worse long-term implant survival. Some studies also reported a higher rate of dislocation, periprosthetic fractures and aseptic loosening.Decisions about the optimal articulation, the utilization of cemented components, dual-mobility cups or constrained liners were not uniform among included studies.THA in patients with Parkinson's disease can offer significant functional gains and pain relief. Surgical considerations pertain to the approach and ways to address instability, whereas emphasis should be placed on appropriate counselling and exploring whether potential improvement of life quality outweighs the risks. Cite this article: 2020;5:856-865. DOI: 10.1302/2058-5241.5.200034.
帕金森病（PD）给关节置换外科医生带来了重大挑战，这是由于肌张力过高、骨折风险增加以及骨质较差。多项研究报告称，PD患者进行髋部骨折手术存在高死亡率、早期失败以及围手术期并发症；然而，关于择期髋关节置换术，尚无更高级别的证据。我们研究的目的是进行一项系统评价，以评估接受择期全髋关节置换术（THA）的帕金森病患者的证据基础和临床结局。我们检索了MEDLINE、EMBASE和Cochrane对照试验中央注册库，以确定评估THA在帕金森病患者中的安全性和临床结局的研究。我们的评价符合系统评价和Meta分析的首选报告项目（PRISMA）指南。我们的系统评价纳入了10项研究，涉及49730名患者。定性综合分析表明，PD患者和对照组在一年死亡率和手术部位感染方面结果相当。PD患者出现更多的医疗并发症，住院时间更长，长期植入物存活率更低。一些研究还报告了更高的脱位、假体周围骨折和无菌性松动发生率。纳入的研究中，关于最佳关节类型、骨水泥固定组件、双动髋臼杯或限制性衬垫的使用决策并不统一。帕金森病患者进行THA可带来显著的功能改善和疼痛缓解。手术考虑涉及手术入路和解决不稳定的方法，而应重点进行适当的咨询，并探讨生活质量的潜在改善是否超过风险。引用本文：2020；5：856 - 865。DOI：10.1302/2058 - 5241.5.200034。
