Parkinson’s disease, subthalamic nucleus stimulation, and total hip arthroplasty: A case report

Abstract

INTRODUCTION Parkinson’s disease is a neurodegenerative disorder causing rigidity, tremor, bradykinesia, and postural instability in addition to the less common cognitive and psychiatric disturbances. The pathophysiology of this disease involves the progressive loss of dopaminergic cells in the midbrain, which in turn leads to loss of dopamine to the basal ganglia. This consequently leads to the classic motor and nonmotor deficits observed in Parkinson’s disease. Previous research has suggested that patients with Parkinson’s disease undergoing total hip arthroplasty (THA), bipolar hemiarthroplasty, or total knee arthroplasty (TKA) have a higher risk of complications, both in the short-term and long-term, than the general population. Rondon et al. showed that patients with Parkinson’s have higher rate of revision surgery, periprosthetic joint infection, periprosthetic fracture, and dislocation. Despite this increased complication rate, Parkinson’s disease is not a contraindication to total joint replacement. On the contrary, recent research has suggested that patients with Parkinson’s and osteoarthritis can achieve good to excellent pain relief long-term after THA with dual mobility implants and cementless fixation. However, this good news is tempered by the fact that they may see worsening disability over time due to progression of Parkinson’s symptoms. Results were similar in a study by Ashraf et al. looking at TKA outcomes in Parkinson’s disease. They showed that TKA can be very effective in alleviating pain related to osteoarthritis in the short-term and long-term in patients with Parkinson’s disease but overall function seems to deteriorate over time due to progression of their disease. These and other studies suggest that even though these patients demonstrate improvement in function after total joint arthroplasty, the magnitude of improvement is less than that seen in controls without Parkinson’s disease and may not be sustained for as long. While the above-mentioned studies document outcomes of primary THA in the general Parkinson population, there are no recent studies in the literature looking specifically at outcomes of THA in patients being concurrently treated with deep brain stimulation (DBS). DBS involves the surgical placement of a stimulator within the brain, either at the subthalamic nucleus (STN) or the globus pallidus internus (GPi), to decrease pain perceived by patients with Parkinson’s disease. Furthermore, studies have shown that both STN and GPi DBS are effective at reducing motor symptoms and dyskinesia by as much as 50%. These studies suggest that perhaps DBSmay improve functional outcomes long-term in patients with Parkinson’s disease undergoing THA and TKA for osteoarthritis. Although there are no long-term data on this topic, we present below the shortterm outcome of a patient with Parkinson’s disease who presented to our clinic with hip osteoarthritis. He underwent concurrent THA and DBS placement, and his clinical course is provided below in the hope that it provokes further fruitful debate on this topic. The patient was informed that details of his case would be submitted for publication and provided written informed consent.