OTSR - 2026-07-10 - Journal Article; Review
Does Parkinson's disease increase the risk of adverse outcomes in patients undergoing total hip arthroplasty? A systematic review and meta-analysis.
Liu Y, Wang J
Topics
Key Takeaway
Parkinson's disease patients undergoing THA face a 2.86-fold increased mortality risk, 1.97-fold increased dislocation risk, and 2.42-fold increased revision risk compared to non-PD controls across 10 comparative studies.
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Summary
This systematic review and meta-analysis asked whether PD independently increases complication risk after THA by pooling 10 comparative studies identified from four databases through July 2025 using a DerSimonian-Laird random-effects model. PD significantly increased dislocation (OR 1.97, 95% CI 1.45–2.68, I²=0%), mortality (OR 2.86, 95% CI 1.75–4.68, I²=86%), and revision (OR 2.42, 95% CI 1.56–3.74, I²=71%). Periprosthetic fracture (OR 4.12), aseptic loosening (OR 3.31), and PJI (OR 1.38) trended higher but did not reach statistical significance, likely due to wide confidence intervals from sparse event data.
Key Limitation
None of the 10 included studies stratified outcomes by PD severity or disease duration, making it impossible to identify which PD patients carry the highest operative risk and should potentially be denied surgery.
Original Abstract
BACKGROUND
Parkinson's disease (PD) is usually considered a contraindication for total hip arthroplasty (THA). While several studies have reported their experience of THA in PD patients, a detailed and updated quantitative synthesis is lacking. Previous reviews have combined single-arm and case-control studies or included a limited number of studies. We conducted this updated systematic review and meta-analysis to answer the following clinical query: Does PD increase the risk of complications in patients undergoing THA?
METHODS
We searched PubMed, Embase, Web of Science, and Scopus from their inception until July 15, 2025, for studies comparing complications (mortality, prosthetic joint infection, revision, fracture, aseptic loosening, dislocation, and readmission) of PD and non-PD patients undergoing THA. The DerSimonian and Laird random-effects meta-analysis model was then used to generate pooled odds ratio (OR) with 95% confidence intervals (CI) for each complication. Cochran's Q statistic and the I 2 index were used to assess heterogeneity between studies. Sensitivity analysis was conducted by sequentially excluding one study at a time from the meta-analysis. Risk of bias was assessed using the Newcastle Ottawa Scale.
RESULTS
Ten studies were included. Meta-analysis showed that the presence of PD significantly increased the risk of medical (OR: 1.44 95% CI: 1.02, 2.03 I 2 = 57%) and surgical complications (OR: 1.61 95% CI: 1.03, 2.52 I 2 = 42%) in PD patients. Meta-analysis demonstrated that the presence of PD significantly increased the risk of dislocation (OR: 1.97 95% CI: 1.45, 2.68 I 2 = 0%), mortality (OR: 2.86 95% CI: 1.75, 4.68 I 2 = 86%), and revision (OR: 2.42 95% CI: 1.56, 3.74 I 2 = 71%). The risk of fracture (OR: 4.12 95% CI: 0.82, 20.7 I 2 = 75%), prosthetic joint infection (OR: 1.38 95% CI: 0.44, 4.29 I 2 = 50%), and aseptic loosening (OR: 3.31 95% CI: 0.89, 12.28 I 2 = 9%) was increased but the effect size was not statistically significant.
CONCLUSIONS
Patients with PD undergoing THA may have a significantly higher risk of medical and surgical complications. Specifically, the risk of dislocation, revision surgery and mortality seems to be significantly increased in patients with PD as compared to controls. There was also a tendency of increased risk of aseptic loosening, fracture, and PJI in PD patients but the summary estimates did not achieve statistical significance.
LEVEL OF EVIDENCE
III.