Knee Replacement in Parkinson’s Disease Portends a Poor Outcome Long Term: But Is it Preventable? By Maria De Leon

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Lately, it seems that a great number of people that I know with Parkinson’s disease has undergone a knee replacement. I wondered if there was a greater incidence of knee replacement in Parkinson’s compared to other neurological diseases. However, my search did not yield much in the way of statistics as to the actual numbers and most articles assumed that knee replacements in Parkinson’s patients were due to age. However, I am not entirely sure this is the cause. Several of the people I know that have undergone replacement would not exactly be placed in the elderly category- even though I must admit that the older I get the younger the less “senior” my peer group becomes. Having said this, I found over 30 articles on the subject from 2017 alone which makes me think that this problem is a lot more widespread than we think and should be evaluated further.

One of the main reasons we need to consider this a complication of poorly controlled Parkinson’s symptoms is because the inherent risk it carries of  long term disability along with a higher mortality and morbidity that has been observed throughout the literature.

First, let’s look at what are the typical causes of knee pain that can eventually lead to need for replacement.

  1. Acute injuries- as well all know having PD makes close friends with the ground- I can’t tell you the times I have fallen and injured myself ever since I got PD. The injuries don’t even have to involve the knee initially to cause pain and problems. Of course, I have nearly shattered my patella (knee cap) when I stumbled in middle of night going to bathroom landing hard on one knee. When the weather is just right it still hurts 5 years later. The other is injuring your back or your feet can lead to abnormal posturing causing problems with knee. Not long after I fallen and sprained my ankles severely I began noticing a searing pain in my knee that would come on suddenly when standing followed by a weakening of my leg which would cause me to fall if not holding on to something.
  2. Overuse injuries– some of us may experience this from excessive exercise. Remember to always have supervision when exercising to avoid injuries and to listen to your body (stop if hurting don’t press on). I find for instance that exercising in deep water is much better for joints than doing water therapy in shallow end. Sometimes even exercises like tai-chi and yoga can cause injuries because of repetitiveness. Plus always remember to stretch before exercising. Everything in moderation. E.g. Iliotibial band syndrome (irritation and inflammation of fibrous band tissue that runs down outside of thigh)
  3. Medical conditions- these include things like lupus, arthritis, Parkinson’s(due to poor posture, abnormal gait as well as joint pain itself from muscle pulling).

Symptoms of Knee pain:

  • Dull burning discomfort
  • Weakness of leg after pain ( sharp shooting pain when in use)
  • Constant ache

What to do to prevent?

  1. Talk to doctor as soon as symptoms begin- As always if not acute – keep diary of when it happens, what triggers it? What makes it better? What makes it worse?
  2. Is it constant? Or comes and goes?
  3. Is there accompanying back pain, foot pain (dystonia/dyskinesia’s)
  4. Are you shuffling?
  5. Are you stooped?
  6. Are you freezing?
  7. Any changes in medication?
  8. Any changes in weight?
  9. Other medical issues? ( arthritis)
  10. Other joints hurting?

Treatments:

  1. Adjust levodopa to improve posture, freezing, on/off, reduce shuffling, as well as decrease rigidity
  2. Start Physical therapy
  3. Botox for dystonia
  4. Steroid injections/anti-inflammatories/ muscle relaxants
  5. Get orthotics, foot inserts or braces for knee and foot- wear cushioned flat shoes
  6. Walk on smooth surfaces
  7. Rest your knee – elevated, massage it, ice/heat
  8. Diet changes if weight is an issue
  9. When standing keep weight equally divided on both legs – avoid standing long time
  10. Don’t sleep on your side- place pillows on sides to avoid rolling

If we follow these steps we can lessen our risk and need for surgery because typically patients with PD who undergo knee and hip replacement have longer hospitalizations, more confusion, require longer rehabilitation along with having a risk of decreased mobility and increased infection post operatively. The key is therapy and sufficient levels of levodopa!

Sources:

https://www.medicalnewstoday.com/articles/319324.php

Total Knee Arthroplasty In Patients With Parkinson’s Disease- A Critical Analysis of Available Evidence.Ashraf M, Priyavadhana S, Sambandam SN, Mounasamy V, Sharma OP. Open Orthop J. 2017; 11:1087-1093. Epub 2017 Sep 30

Total joint arthroplasty in patients with Parkinsons: survivorships, outcome and reasons for failure. Rondon AJ, Tan TL, Schlitt PK, Greenky MR, Phillips JL, Purtill JJ. J Arthroplasty. 2018 Apr;33(4):1028-1032. doi: 10.1016/j.arth.2017.11.017. Epub 2017 Nov 16.PMID: 29199060

Outcomes of primary total knee arthroplasty in patients with parkinsons. Wong EH, Oh LJ, Parker DA. J Arthroplasty. 2018 Jun;33(6):1745-1748. doi: 10.1016/j.arth.2018.02.028. Epub 2018 Feb 14.

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all right reserved Maria De Leon MD

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