Parkinson's disease and Hip Arthritis: Special considerations for treatment

Hip arthritis is a common challenge for patients with Parkinson’s disease (PD). Muscle stiffness, tremors, and changes in mobility due to PD can accelerate the wear and tear on the hip joint, leading to pain and decreased function. For Parkinson’s patients, managing hip arthritis and considering hip replacement surgery involves unique challenges that require specific attention. This article outlines key considerations and the importance of selecting the right surgeon to address these needs.

Why Parkinson’s Patients Are More Susceptible to Hip Problems

Patients with Parkinson’s often experience changes in body mechanics due to muscle rigidity, postural instability, and bradykinesia. These changes place additional strain on the hip joint, leading to accelerated cartilage wear and contributing to the development of arthritis. Additionally, balance issues and decreased mobility can exacerbate hip pain and stiffness.

Challenges in Managing Hip Arthritis in Parkinson’s Patients

Managing hip arthritis in Parkinson’s patients is more complex because:

• Balance and Mobility Issues: Parkinson’s patients often struggle with balance, making it even more critical to treat hip arthritis early to maintain mobility and prevent loss of function.
• Increased Risk of Falls: Painful hips can lead to an increased risk of falls, while joint stiffness and muscle rigidity add strain during a fall, heightening the risk of serious injuries like hip fractures.
• Compounded Muscle Stiffness: Muscle stiffness in Parkinson’s patients can intensify the pain and symptoms of hip arthritis, making everyday activities more challenging.

When to Consider Hip Replacement

For many patients, hip replacement becomes an option when non-surgical treatments—such as physical therapy, medications, or injections—are no longer effective. However, Parkinson’s patients have a unique set of surgical risks, and choosing a surgeon experienced with Parkinson’s disease is critical in the decision-making process. Working closely with a healthcare provider to evaluate surgical candidacy and postoperative care is essential for a successful outcome.

Choosing the Right Surgeon: Critical Factors

1. Addressing the Risk of Hip Dislocation and Maximizing Stability

Patients with Parkinson’s are at a higher risk of hip dislocation after replacement due to tremors, spasticity, and muscular imbalance. Additionally, their significant muscle stiffness may require adjustments to the positioning of the hip implant or the use of specialized implants to maximize stability while preserving motion.

Dr. Trevor Stefanski uses a combination of preoperative specialized X-rays, which assess the dynamic position of the pelvis in both sitting and standing positions, along with intraoperative image guidance to ensure precise placement of the hip components. Proper component positioning is crucial to minimizing dislocation risk.

Additionally, the muscles, tendons, and soft tissues surrounding the hip joint play a critical role in maintaining joint stability. Dr. Stefanski’s minimally invasive, muscle-sparing approach preserves these structures, enhancing joint stability while promoting a quicker recovery with less pain.

2. Managing the Risk of Fracture

Patients with Parkinson’s disease are also at a higher risk of fractures during and after surgery due to muscle rigidity and osteoporosis. Adjustments to standard surgical techniques are often necessary to minimize these risks.

Typically, implants are press-fitted into the bone by wedging them tightly for initial stability, with the bone eventually growing into the implant to provide long-term fixation. However, Parkinson’s disease and osteoporosis can alter the quality and shape of the bones, making it difficult—or even impossible—to achieve the necessary tight fit using standard implants. Additionally, attempting to achieve this tight fit through press-fitting can increase the risk of fractures due to fragile bones.

In such cases, cemented implants offer a valuable alternative by providing immediate and secure fixation. While cementation was once the standard of care for all hip replacements, advancements in press-fit technology have made the need for cementation fairly rare. As a result, it is not uncommon for surgeons to leave residency with limited or somtime NO experience with cementing hip replacements.

Choosing a surgeon who is experienced and proficient in a wide variety of specialized implants and techniques, as well as the specialized needs of Parkinson's patients, is essential for ensuring the best possible outcome and minimizing potentially catastrophic complications, such as fractures or unstable implants.

Rehabilitation and Recovery Considerations

After surgery, rehabilitation is crucial for Parkinson’s disease patients. Standard physical therapy can help achieve a good outcome, but for the best possible results, Dr. Stefanski recommends involving patients in a Parkinson’s-specific community, such as Parkinson’s Community Fitness, in Blue Ash, OH, which provides specialized exercise programs and a supportive community where patients can safely work through their rehab journey, surrounded by people who understand their needs and have shared experiences.

Conclusion: Personalized Care for a Better Outcome

For Parkinson’s patients considering hip replacement, it is crucial to work with a surgeon experienced in addressing the special needs of this population. Dr. Trevor Stefanski utilizes a combination of minimally invasive, muscle-sparing techniques, advanced image guidance, and special techniques such as cementing when necessary, to ensure that patients receive the highest standard of care. By combining this expertise with dedicated rehabilitation programs like those offered at Parkinson’s Community Fitness, patients can achieve better outcomes and a higher quality of life.