Total shoulder arthroplasty in patients with Parkinson's disease

Treatment of orthopaedic problems in patients with Parkinson's disease can be problematic and include failure of fixation or prosthetic dislocation. A study was undertaken to assess the outcome of total shoulder arthroplasty in this patient group. Fifteen patients with Parkinson's disease underwent 16 unconstrained shoulder arthroplasties. Thirteen of the patients had mild to moderate Parkinson's disease according to the Hoehn and Yahr score. Average length of follow-up was 5.3 years, ranging from 1.2 to 15 years. After surgery, patients had significant relief of pain (p < 0.01); however, functional results were surprisingly poor. With the Neer result rating system four shoulders achieved excellent results, and two had satisfactory results. Ten patients had a change in joint position, mainly superior subluxation. Three patients required revision surgery, two for symptomatic subluxation and one for glenoid loosening. Older patients (> 65 years) did significantly worse, but this factor did not account for all the unsatisfactory outcomes. Duration of Parkinson's disease, Hoehn and Yahr score, Levodopa dose, and rigidity, arm swing, or rapid alternating movement scores were not found to be significant predictive factors. We conclude that despite successful pain relief, the functional results of total shoulder arthroplasty in patients with Parkinson's disease are poor, especially in patients older than 65 years of age, and complications are more frequent.