REVERSE TOTAL SHOULDER ARTHROPLASTY IN PATIENTS WITH PARKINSON'S DISEASE

摘要

Introduction: Parkinson's disease is associated with increased muscle tone tremor and high risk of falls. Poor outcomes have been reported with anatomic total shoulder arthroplasty and there is concern regarding the potential for poor outcomes of reverse total shoulder arthroplasty (rTSA). Aim: The study purpose was to report rTSA outcomes in patients with Parkinson's disease. Methods: We identified all patients treated with rTSA who also had a diagnosis of Parkinson's disease. Data was collected prospectively. Clinical outcomes were Constant score Pain score Subjective Shoulder Value (SSV) strength range of movement and complications. Mean follow-up was 49 months. Results: There were 9 shoulders in 7 patients 2 bilateral. 5 were revision surgeries to rTSA: 1 from anatomic TSA 2 from hemiarthro-plasty and 2 from resurfacing. Mean age at surgery was 7ly 3m. Mean Constant score improved from 24.1 (Adjusted 32.2) preoperatively to 65.8 (Adjusted 91.1) postoperatively (p<0.0001). Pain Score (No pain= 15) improved from 5.6/15 to 13.7/15 (p<0.005) and SSV from 1.4/10 to 8.4/10 (p<0.005). Strength improved from 2.41b to 9.51b (p = 0.0001). Mean postoperative movement was 132 forward flexion 121 abduction 26 external rotation and 85 internal rotation. All patients could reach to or beyond the top of their head and their sacroiliac joint. There was no difference between 1-year follow-up and final follow-up scores. All patients were happy with surgery rating 8 shoulders as "much better" and 1 as "better" than preoperatively. There were no intra-operative surgical complications. X-ray review showed only 2 cases of non-progressive Grade 1 glenoid notching. There were no lucencies subsidence or stress shielding. No periprosthetic fractures occurred. Conclusion: Parkinson's disease should not be considered a contraindication for rTSA. Patients with Parkinson's can expect good clinical and radiographic outcomes and high rates of satisfaction. rTSA allows return to activities of daily living and functional independence.