Functional outcomes of total knee arthroplasty in patients with Parkinson's disease: A case control study

Parkinson's disease is a neurodegenerative condition causing coordination loss in musculoskeletal system. Many studies suggest that total knee arthroplasty in patients with Parkinson's disease has unfavorable treatment results and high complication rates. Our hypothesis was that total knee arthroplasty might be an effective procedure in patients with Parkinson's disease.

Parkinson's disease patients who underwent total knee arthroplasty between 2006 and 2018 were retrospectively evaluated. Patients who had Parkinson's disease diagnosis before surgery and who had a minimum follow-up duration of 12 months were included. Secondary knee osteoarthritis patients were excluded. A matched control group was randomly formed. Outcome measures were evaluated by preoperative and postoperative Knee Society Score and joint range of motion values. Comparison was made by means of increase in Knee Society Score and range of motion values. Study group patients were reviewed according to Columbia Classification System to determine disease severity. Stages I-II were accepted as "low-grade" and III-IV-V as "high-grade" disease. Another comparison was made between "low-grade" and "high-grade" patients. Patient who showed disease progression after surgery were also compared to patients without progression.

There were 13 patients in both groups. In study group, mean preoperative and postoperative Knee Society Score values were 45.4 (±16.8) and 85.6 (±7.60); range of motion values were 93.9° (±17.0°) and 99.5° (±9.37°) respectively with a mean follow-up of 64.5 (±44.7) months. In control group, mean preoperative and postoperative Knee Society Score values were 38.8 (±11.5) and 86.1 (±10.0); range of motion values were 100.4° (±14.6°) and 109.2° (±10.2°) respectively with a mean follow-up of 51.8 (±13.6) months. No significant difference was observed between 2 groups (p > 0.05). Mean preoperative KSS and ROM values were significantly lower in high-grade patients (30.0 (±17.0) and 78.8° (±11.8°) respectively) compared to low-grade patients (52.2 (±11.9) and 100.6° (±14.7°) respectively) (p < 0.05). However, mean increase in KSS and ROM values were significantly higher for high-grade patients (p < 0.05). Mean increase in Knee Society Score and range of motion was 32.4 (±10.9) and 1.00° (±9.46°) respectively in patients with progression, 45.4 (±16.8) and 8.63° (±8.00°) in patients without progression (p > 0.05).

Total knee arthroplasty is a successful treatment of knee osteoarthritis in Parkionson's disease patients with similar outcomes compared to general population despite disease severity and progression.