Prótesis total de rodilla en pacientes con enfermedad de Parkinson: Resultados preliminares

• Autores: Juan Pablo Bonifacio, Matías Costa Paz, Lisandro Carbo, Carlos Yacuzzi, Emilio Corinaldesi
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 79, Nº. 2, 2014, págs. 99-106
• Idioma: español
• DOI: 10.15417/224
• Títulos paralelos:
  • Total ­knee­ arthroplasty­ in­ Parkinson’s ­disease­ patients: Preliminary results
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    In­tro­duc­ción: La enfermedad de Parkinson es un trastorno neurodegenerativo progresivo y crónico, con una incidencia aproximada de 31/100.000 habitantes en la Argentina. El objetivo de este estudio fue analizar un grupo de pacientes con enfermedad de Parkinson sometidos a artroplastia total de rodilla.Materiales­ y ­Métodos:­ Entre 2009 y 2011, se evaluó a 11 pacientes (edad promedio 68 años, rango 65-80) con enfermedad de Parkinson que fueron operados por artrosis de rodilla con prótesis cementadas estabilizadas a posteriori. Todos fueron evaluados con la escala analógica visual para el dolor, el Knee Society Scoring, el WOMAC y el grado de satisfacción subjetiva. El grado de afectación de la enfermedad de Parkinson se determinó con la escala modificada de Hoehn y Yahr. Se registraron las complicaciones.Resultados: El seguimiento promedio fue de 2 años (rango 1-3). Las evaluaciones para dolor y funcionales arrojaron los siguientes resultados: la escala analógica visual para el dolor mejoró 3 puntos promedio; KSS dolor 37/74; KSS funcional 36/51, WOMAC 67/31. El grado de satisfacción de los pacientes fue de bueno a excelente en 7 casos. La escala modificada de Hoehn y Yahr fue de 1,5 puntos en el preoperatorio y de 2,6 puntos en el posoperatorio. Hubo 6 complicaciones: dos síndromes confusionales, una trombosis venosa profunda, una luxación protésica y dos prótesis dolorosas.Conclusión:­ La artroplastia total de rodilla en pacientes con enfermedad de Parkinson es un procedimiento que mejora los resultados funcionales y el dolor, pero provoca mayores complicaciones que en la población general. 

  • English

    Background: Parkinson’s disease is a progressive, chronic, neurodegenerative disorder with an approximate incidence of 31/100,000 persons in Argentina.The aim of this study was to assess a group of patients with Parkinson’s disease who underwent total knee arthroplasty.Methods:­ Between 2009 and 2011, 11 patients with Parkinson’s disease (average age 68 years, range 65-80) who underwent cemented posterior stabilized total knee arthroplasty for osteoarthritis were retrospectively reviewed. All patients were evaluated with a visual analogue scale for pain, the Knee Society Scoring, the WOMAC and the degree of subjective satisfaction. Degree of Par- kinson severity was measured with the Modified Hoehn and Yahr Scale. Complications were recorded.Results: The average follow-up was two years (range 1-3). Results for pain and function were: visual analogue scale for pain improved an average of 3 points; KSS pain 37/74; functional KSS 36/51, WOMAC 67/31. Satisfaction was good to excellent in 7 cases. The Modified Hoehn and Yahr Scale was 1.5 points preoperatively and 2.6 points postoperatively. There were 6 complications: two confusional syndromes, a deep venous thrombosis, a prosthetic dislocation and two painful prostheses.Conclusion: ­Total knee arthroplasty in patients with Parkinson’s disease is a procedure that improves functional outcomes and pain, but it produces more complications than in the general population.  

• Referencias bibliográficas
  • Huse DM, Schulman K, Orsini L, Castelli-Haley J, Kennedy S, Lenhart G. Burden of illness in Parkinson’s disease.
  • Mov Disord 2005;20(11):1449-54.
  • Barbosa ER, Limongi JC, Cummings JL. Parkinson’s disease. Psychiatr Clin North Am 1997;20(4):769-90.
  • Weintraub D, Comella CL, Horn S. Parkinson’s disease: Part 1. Pathophysiology, symptoms, burden, diagnosis, and
  • assessment. Am J Manag Care 2008;14(2):S40-S48.
  • Wood BH, Bilcough JA, Walker RW, Bowron A. Incidence and prediction of falls in Parkinson’s disease: a prospective
  • multidisciplinary study. J Neurol Neurosurg Psychiatry 2002;72:721-5.
  • Leibson CL, Maraganore DM, Bower JH, Ransom JE, O’Brien PC, Rocca WA. Comorbid conditions associated with
  • Parkinson’s disease: A population-based study. Mov Disord 2006;21(4):446-55.
  • Geller JA, Macaulay W, Brown AR, Cote LJ, Kiernan HA. Total knee arthroplasty and Parkinson disease: enhancing
  • outcomes and avoiding complications. J Am Acad Orthop Surg 2010;18:687-94.
  • Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop 1989;(248):13-14.
  • Bellamy N, Buchanan WW. A preliminary evaluation of the dimensionality and clinical importance of pain and disability in
  • osteoarthritis of the hip and knee. Clin Rheumatol 1986;5:231-41.
  • Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967;17(5):427-42.
  • Duffy GP, Trousdale RT. Total knee arthroplasty in patients with Parkinson’s disease. J Arthroplasty 1996;11(8):899-904.
  • Vince KG, Insall JN, Bannerman CE. Total knee arthroplasty in the patient with Parkinson’s disease. J Bone Joint Surg Br
  • ;71(1):51-4.
  • Mehta S, VanKleunen JP, Robert E, Booth RE, Lotke PA, Lonner JH. Total knee arthroplasty in patients with Parkinson’s
  • disease: Impact of early postoperative neurologic intervention. Am J Orthop 2008;37(10):513-6.
  • Oni OO, Mackenney RP. Total knee replacement in patients with Parkinson’s disease. J Bone Joint Surg Br 1985;67(3):424-5.
  • Erceg M, Maricevic A. Recurrent posterior dislocation following primary posterior-stabilized total knee arthroplasty. Croat Med
  • J 2000;41(2):207-9.
  • Coughlin L, Templeton J. Hip fractures in patients with Parkinson’s disease. Clin Orthop 1980;148:192-5.
  • Eventov I, Moreno M, Geller E, Tardiman R, Salama R. Hip fractures in patients with Parkinson’s syndrome. J Trauma
  • ;23:98-101.
  • Whittaker RP, Abeshaus MM, Scholl HW, Chung SM. Fifteen years’ experience with metallic endoprosthetic replacement of
  • the femoral head for femoral neck fractures. J Trauma 1972;12:799-806.
  • Weber M, Cabanela ME, Franklin H, Frassica SFJ, Scott W. Total hip replacement in patients with Parkinson’s disease.
  • International Orthopaedics (SICOT) 2002;26:66-8.
  • Evans JR, Mason SL, Williams-Gray CH, Foltynie T, Brayne C, Robbins TW, et al. The natural history of treated
  • Parkinson´s disease in an incident, community base cohort. J Neurol Neurosurg Psychiatry 2011;82:1112-8.
  • Fahn S, Elton RL. Development Committee UPDRS: Unified Parkinson’s Disease Rating Scale. En: Fahn S, Marsden CD,
  • Goldstein M, Teychenne P (eds.) Recent Developments in Parkinson’s Disease. New York, NY: MacMillan; 1986:153-63.
  • Brosseau L, Milne S, Wells G, Tugwell P, Robinson V, Casimiro L, et al. Efficacy of continuous passive motion following total
  • knee arthroplasty: A metaanalysis. J Rheumatol 2004;31(11):2251-64.
  • Bonifacio y cols. Rev Asoc Argent Ortop Traumatol
  • Fast A, Mendelsohn E, Sosner J. Total knee arthroplasty in Parkinson’s disease. Arch Phys Med Rehabil 1994;75(11):1269-70.
  • Goetz CG, Tanner CM, Levy M, Wilson RS, Garron DC. Pain in Parkinson´s disease. Mov Disord 1986;1(1):45-9.
  • Waseem S, Gwinn-Hardy K. Pain in Parkinson´s disease; common yet seldom recognized symptom is treatable. Postgrad Med
  • ;110(6):33-40