TOTAL SHOULDER ARTHROPLASTY IN PATIENTS WITH PARKINSONS-DISEASE

Treatment of orthopaedic problems in patients with Parkinson's disease can be problematic and include failure of fixation or prosthetic disl ocation. A study was undertaken to assess the outcome of total shoulde r 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 surprising ly poor. With the Neer result rating system Four shoulders achieved ex cellent results, and two had satifactory results. Ten patients had a c hange in joint position, mainly superior subluxation. Three patients r equired 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 no t found to be significant predictive Factors. We conclude that despite successful pain relief, the functional results of total shoulder arth roplasty in patients with Parkinson's disease are poor, especially in patients older than 65 years of age, and complications are more freque nt.