PARKINSON'S DISEASE PATIENTS EXPERIENCE HIGHER ODDS OF 90-DAY ADVERSE EVENTS AND LOWER FIVE-YEAR IMPLANT SURVIVAL FOLLOWING TOTAL JOINT REPLACEMENT: A MATCHED COHORT ANALYSIS

Parkinson's Disease (PD) is a progressive neuromuscular disorder associated with tremor, bradykinesia, rigidity, and postural instability that classically affects an older patient population. Total hip arthroplasty (THA) and total knee arthroplasty (TKA), together referred to as total joint arthroplasty (TJA), are well-established surgical procedures for patients with end-stage osteoarthritis that have failed conservative treatment. PD patients may be considered as candidates for TJA, however, short and long-term outcomes remain poorly characterized in this patient population. All patients undergoing primary THA or TKA for osteoarthritis in the 2010–2019 PearlDiverdatabase with least 90 days of postoperative follow-up were identified. Those with PD were matched 1:1 to patients without PD based on age, sex, and comorbidity burden. Ninety-day adverse events were assessed and compared using multivariate logistic regression. Five-year implant survival was determined and compared using Kaplan-Meier implant survival curves. Significance was set at P < 0.05. In total, 2,552 PD patients who underwent THA and 4,390 PD patients who underwent TKA were identified. Compared to their matched control cohorts, both PD patient populations had significantly higher odds of falling, urinary tract infection, periprosthetic joint infection, fracture, dislocation, and readmission (Figure 1). Additionally, PD patients undergoing TKA experienced higher odds of pneumonia, pulmonary embolism, deep vein thrombosis, cardiac complications, acute kidney injury, wound dehiscence, aseptic loosening, and mechanical complications. At 5 years, implant survival for those with PD was significantly lower than patients without PD for both THA and TKA (P < 0 .001 for both) (P < 0.001 for both; Figure 2). The current study represents the largest matched cohort analysis of PD patients undergoing TJA to date. PD patients demonstrated significantly higher odds of several short-term adverse events, as well as lower 5-year implant survival rates. In light of the increased risk of various medical and surgical complications following TJA among PD patients, TJA should be approached cautiously in this patient population and deserves increased surveillance in the perioperative period. Limitations of the present study include potential inaccuracies in incidence and odds of reported outcomes due to errors and discrepancies in coding of data in the PearlDiver database. For any figures or tables, please contact the authors directly.