Is Parkinson’s disease associated with worse outcomes following hip replacement for treatment of acute hip fracture?

Abstract

The prevalence of Parkinson’s disease (PD) is increasing. Targeted research evaluating clinical outcomes following hip arthroplasty (HR) for acute hip fractures in this high-risk group of patients is lacking. This study evaluates whether PD is associated with worse outcomes with regards to revision rate and mortality in patients who sustain hip fractures treated with total or hemiarthroplasty.

Between 2005 and 2012, 1,204 patients with PD who underwent HR surgery following acute hip fracture were identified in the Swedish Hip Arthroplasty Register. A control group was generated, with 1 :1 exact matching for potentially confounding variables. Risks of revision and mortality were compared at predetermined intervals over a six-year study period, using Kaplan-Meier and Log-rank testing.

No significant differences were detected in revision rates between PD and control groups at 30 days (p=0.71), 90 days (p=0.85), one-year (p=0.51) and six- years (p= 0.40). Increased mortality was observed in the PD group at all time periods assessed. Log-rank testing identified these differences to be significantly higher at 90 days (p<0.01) and on completion of the six-year study period (p<0.001). Differences in mortality rates observed at interim periods of 30 days (p=0.06) and one year (p=0.07) were not shown to be of statistical significance.

Patients with PD had increased risk for mortality following total or hemiarthroplasty after a hip fracture, however we were unable to identify an increased risk of revision. As increased incidence of hip fracture sustained by PD patients is predicted,multidisciplinary care must be prioritised to improve outcomes.