Arthroplasty In Patients With Parkinsons Disease
An interview with Lee M. Zuckerman, MD
An article in the January 2009 issue of the Journal of the AAOS reviews the evaluation and treatment of orthopaedic conditions in patients with Parkinsons disease . In an interview with AAOS Now, author Lee M. Zuckerman, MD, chief orthopaedic resident at SUNY Downstate Medical Center in Brooklyn, N.Y., focused on issues relating to total joint arthroplasty in Parkinsons patients.
AAOS Now: Is it true that the tremors experienced by a patient with Parkinsons will loosen an implanted prosthesis?
Dr. Zuckerman: No real data exists on this issue, or on whether a cemented or press-fit implant is better for patients with PD. Because patients with PD have tremors and rigidity, one theory was that the constant motion and muscular imbalance would prevent proper incorporation and increase the wear of the implant, leading to failure. In initial studies, patients were immobilized in an attempt to counteract this, but this resulted in worsening of the rigidity and tremor. Patients who are mobilized early actually do better and have similar short-term outcomes to patients without PD.
Parkinsons disease doesnt seem to be a real contraindication for TJA its more an issue of getting the patient mobilized to prevent the symptoms from worsening and proper patient selection.
AAOS Now: Is there any reason not to perform TJA on a patient with PD?
AAOS Now: Is one treatment better than another for hip fractures in patients with Parkinsons disease?
Akinetic Crisis And Pain
This type of pain may occur in the advanced stages of Parkinsons. Its brought on by akinetic crisis, which is a rare and sometimes dangerous complication of Parkinsons.
Akinetic crisis involves a worsening of Parkinsons symptoms, which can include severe rigidity, a complete loss of movement, fever and difficulty swallowing. People with Parkinsons who have akinetic crisis pain say that they feel pain in their muscles and joints, and experience headaches. Some people also experience whole-body pain.
This type of pain can be brought on if you abruptly stop taking Parkinsons medication, or if you develop an infection, both of which can cause Parkinsons symptoms to suddenly get worse. Akinetic crisis requires urgent medical help. If it looks like someone is experiencing akinetic crisis, call 999.
Hip Pain Caused By Bursitis
Bursitis develops when a bursa becomes swollen. A bursa is a tiny fluid-filled pad that acts as a cushion between the muscle and bone. It plays an important role in making your joints more flexible.
The most common areas for bursitis are in your hips, elbows, and shoulders. Even though bursitis can develop in younger people, its more common in people who are diabetic, overweight, and the elderly.
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What Is The Quality Of The Reviewed Studies
Overall, quality scores were mediocre for both non-intervention and intervention studies. The main points that studies scored low on were sample size justification, electrode placement procedures and signal processing techniques. Individuals with PD exhibit great heterogeneity and generally high inter- and intra- subject gait EMG variability necessitating greater sample sizes than for HOA. However, the median sample size was only twenty-two and no study in this review performed power analysis to justify their selection of participant number. Most studies included a greater proportion of males, reflecting the gender bias in PD although some studies did not specify gender. Gender differences in muscle activity during walking have previously been reported, indicating it is an important factor. Only four studies determined electrode location using validated guidelines such as the SENIAM guidelines. Identification of the optimal electrode site helps ensure the signals with higher signal to noise ratio are recorded from the selected muscle with minimal cross-talk from adjacent muscles.
Over half of the studies did not report any signal normalisation methods,,,,,,,,. Such normalisation is essential to allow comparisons of EMG between muscles, sessions and participants as factors such as thickness of adipose tissue, presence of oedema and number and orientation of muscle fibres will modify amplitude,. Excluding normalisation can invalidate subsequent results.
Functional Exercise For Chronic/persistent Pain
There are some simple exercises that you can try around the house to help:
- If you experience pain in your legs, keep them strong by practising standing up and sitting down in a chair.
- If your shoulders are aching, start by loosening them with some shoulder rolling actions, then by lifting an object that is slightly weighty from a shelf, and then replacing it. This increases the range of movement in your back, shoulders and arms, and then your strength.
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Causes Of Groin Pain That Comes From The Hip
Groin pain that originates in your hip can vary in how it feels. It can be either sharp or dull, and either sudden or gradual. Its type and severity will depend on its cause.
If your pain results from problems in your muscles, bones, tendons, or bursae, it will probably become worse when you move.
Learn what conditions originating in your hip might be causing your groin pain, and the best treatment options.
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Maintaining Your Normal Pd Medication Schedule
Maintaining your PD medication schedule is crucial for anyone with PD. The correct timing and dosage are essential to your comfort and well-being. However, oftentimes when undergoing surgery, there may be restrictions regarding when you can and cannot take medications. Here are a few tips to navigate this issue:
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What Are The Treatment Options For Parkinsons Disease
When a person suffers from Parkinsons disease, the nerve cells fail to produce enough dopamine to send signals to the brain to control conscious and unconscious actions. The condition gets progressively worse over time.
However, there are means through which one could reduce the impact of this condition to a certain extent. Such treatment options include medication, surgery, and physical therapy.
Medication
As the symptoms such as tremors, muscle stiffness, and walking issues start to appear, doctors may prescribe certain commonly regarded medications such as Levodopa, MAO B Inhibitors, Dopamine Agonists and Antivirals.
These medicines are, however, more useful at the initial stages of the disease. After time elapses, these medications start to lose the effectiveness they had at earlier stages.
The prescription and dosage depend on the severity of the condition.
Surgical Procedures
In the case of Parkinsons disease, a surgical procedure known as Deep Brain Stimulation has provided patients with good results.
A wire is placed inside of the patients brain and helps the brain more effectively receive electrical signals. If effective, this improves the functioning power of the brain.
Physical Therapy
Physical therapy can help patients deal with the effects of Parkinsons disease. Specially designed exercises such as breathing, stretching, rhythmic, static and dynamic exercises are implemented to relieve some of the pain experienced by the patient.
Stooping Or Hunched Posture
People who have Parkinsons disease may notice changes in their posture due to other symptoms of the disease, such as muscle rigidity.
People naturally stand so that their weight is evenly distributed over their feet. However, people who have Parkinsons disease may start bending forward, making them appear hunched or stooped over.
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Q Which Pharmacotherapies Are Best For Treating Pain In Pd
Dr. Fleisher: The first step is to make sure that Parkinsons medications are optimized. For example, dystonic or musculoskeletal pain may be caused by Parkinsons motor symptoms when dopamine levels are too low. If the patient is able to keep a pain diary, it may show a clear pattern of pain occurring the hour before each dose or before specific doses, suggesting the need to either increase the dosage preceding the pain episode, increase the frequency of medication dosing, or use adjunctive dopaminergic therapies to achieve more steady dopamine levels throughout the day.
In addition, optimal management of comorbidities that may contribute to pain is needed. The choice of pain medication depends on the pain type.
The first lines of treatment for musculoskeletal pain can be heat and cold packs and nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen.
For dystonic pain, adjustment of dopaminergic medications is particularly critical however, if dystonia consistently occurs in 1 particular body part, botulinum toxin injections also can be helpful. The goal of botulinum toxin injection is to weaken the muscle enough to stop the abnormal contractions and twisting, but the patient may lose function in the body part as a result . Thus, patient counseling is important to manage expectations.
When Hip Pain Turns Into Parkinsons Disease
Received a referral from an orthopod for home physical therapy to see a client who had fallen at home. She had both hips replaced in the last few years. The referral said Left Hip Pain. Eval and Treat. I figured I was walking into a situation of someone who had a painful left hippossible hip contusionprobably would need a home safety assessment, some ice/heat, massage, gentle stretching and move toward more aggressive strengthening and fall prevention strategies.
When I saw her, she could hardly move and was in a lot of pain from the most recent fall that occurred the night before. Pain not from her hip but instead her back and left rib area because of the latest fall. She could hardly move from the pain. I arranged for an x-ray for possible rib or spinal fractures. The x-ray did show left side rib fractures.
So, I prodded a little deeper. Reviewed her medications againhmmdepakote, clonazepam and about ten other meds including a narcotic for the pain. That explains itor does it?
It is very easy to get tunnel visioned into seeing what the referral script saysleft hip pain. But do I see the tree and miss the forest. A tree can tell you a lot, but step back and look at the forestyou may be surprised at the view.
This is one reason I love working as a home health physical therapist. I can make time to look at the tree and even step back and view the forest.
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Pain Is A Common But Overlooked Problem In Parkinsons Disease
Pain is an often overlooked non-motor symptom of Parkinsons disease . Studies show that between 40-80% of people with PD report pain, which is likely why it is often suggested as a topic for this blog.
One of the reasons why the topic of pain and PD is difficult to address is that it is sometimes tough to discern whether a particular pain is due to PD or not. Chronic pain is such a common symptom among the general population, and people with PD are not immune to common problems as well. However, there are aspects of PD that may exacerbate the pain experienced from a common problem. In addition, there are particular types of pain that may be unique to people with PD.
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How Is This Disorder Treated
SHS is often painless and may not require medical treatment. If it causes minor pain, your doctor may recommend pain relievers and an cold compress. You may also be required to limit physical activity to allow your muscles and tendons to heal.
In more serious cases, you may need physical therapy to increase your range of motion or steroid injections for pain relief. There are also exercises you can do to strengthen and stretch your surrounding muscles and relieve symptoms.
Some common exercises to treat SHS include:
Iliotibial band stretch
Lying-down hamstring stretch
Common procedures for SHS include:
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Medication Errors On Admission
The medication history is not always readily available on admission with a hip fracture, and verbal and non-verbal communication difficulties, delirium or presence of dementia may complicate this further. Parkinson’s disease patients often have personalized and precisely timed medication schedules, which might conflict with established drug round timings on the wards. Up to 75% of acute medical and 25% of surgical admissions in Parkinson’s disease patients are associated with omission, alteration or mistiming of Parkinson’s medication. Hip fractures incur similar inadvertent pharmacomodulation, and the vagaries of the trauma theatre lists and nil-by-mouth instructions further compound the problem. Its sequelae are serious and potentially life-threatening, including worsening rigidity, further injuries from falls, pressure sores, aspiration pneumonia and neuroleptic malignant syndrome. A multidisciplinary approach can help reduce these medication errors.
Risk Of Dislocation And Failed Fixation
The rigidity in Parkinsons disease was historically cited as a reason to avoid hemiarthroplasty in intracapsular fractures. Coughlin and Templeton reported a 37% dislocation rate. The widespread uptake of Levodopa and other pharmacotherapy in the late 1970s and early 1980s may have contributed to the declining dislocation rates in subsequently published papers. In 1988, Staeheli et al. observed one dislocation in 50 implanted hemiarthroplasties performed through a variety of surgical approaches . Turcotte et al. in 1990 reported 5 dislocations in their study with 47 posterior-approach hemiarthroplasties. Nonetheless, the relative dislocation rate seems to have remained constant, with both Whittacker et al. and Hammer reporting 3 to 4 times higher rates than in non-Parkinsons disease patients. Walker found that the re-operation rate was four times that in Parkinsons disease patients with hip fractures . Similarly, Karadsheh et al. have recently reported higher rates of dislocation, failed fixation and revision surgery in their cohort of 141 Parkinsons disease hip fracture patients compared with 282 patients matched for age, gender, ASA and operation type.
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Total Hip Arthroplasty In Patients With Parkinson Disease: Improved Outcomes With Dual Mobility Implants And Cementless Fixation
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance PubliqueHôpitaux de Paris, FranceAnatomy Department Faculté Pitie Salpetriere UPMC, Paris, France
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance PubliqueHôpitaux de Paris, FranceInstitut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, FranceDepartment of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Aidin Eslam PourCorrespondenceReprint requests: Aidin Eslam Pour, MD, Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, SPC 5328, 1500 E. Medical Center Dr., Ann Arbor, MI 48109.Affiliations
Exercises For Parkinsons Disease
The chiropractor could also recommend exercises for the patient to try at home to maintain wellness in between visits. Aerobic exercises are performed to increase the delivery of oxygen within the body and assist neurotransmitters in keeping the heart, lungs, and nervous system healthy. Patients with PD are often found to benefit from exercises that feature changes in tempo, activity, or direction, as these promote the improvement of the patients ability to shift between activities or multitask. Rhythmic activities, such as dancing, skipping and cycling are also encouraged.
Walking, swimming, hiking, and aerobics are just a few activities that the patient could do both alone and with friends or a class. Anyone who engages in exercise should switch up their routine between rhythmic, repetitive movements and random practice exercise. These exercises are meant to relieve stiffness, reduce depression, and improve mobility, balance, posture, and gait. Natural symptom relief and quality of life improvements are the easiest treatments that a PD patient can try.7
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Can Parkinsons Be Genetic
According to the researches done so far it has been found that there is a possibility of some form of Parkinsons disease due to genetic mutations. However, the hereditary causes of this disease are quite rare. Around 15% of patients having Parkinsons disease are seen to have a family history of the same. It has been seen that a history of Parkinsons disease running in the family may increase the risk of a person to get it. Having a first-degree family member with Parkinsons essentially raises the risk to 3%. The statistics show that having a parent or sibling with Parkinsons disease may slightly increase the risk.
Parkinson Disease Associated Differences In Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis
Article type: Research Article
Authors: Fullard, Michellea * | Thibault, Dylanb c | Zisling, Hanand | Crispo, James A.c d | Willis, Allisonb c e
Affiliations: Department of Neurology, University of Colorado, Aurora, CO, USA | Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA | Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA | University of Delaware, Newark, DE, USA | Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
Correspondence: Correspondence to: Michelle Fullard, MD, MS, Department of Neurology, University of Colorado, Mail Stop B185, 12631 E 17th Avenue, Aurora, CO 80045, USA. Tel.: +1 303 724 8295 Fax: +1 303 724 2212 E-mail: .
Keywords: Parkinsons disease, cohort studies, arthroplasty, knee replacement, hip replacement
DOI: 10.3233/JPD-201992
Journal: Journal of Parkinson’s Disease, vol. 10, no. 4, pp. 1577-1586, 2020
Abstract
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