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Wednesday, June 19, 2013
Parkinson's Disease and knee replacement surge
My brother-in-law, age 83 has had parkinsons disease for a number of years. He is considering knee replacement surgery. His health is good(vitals, etc)except for the Parkinsons What are the implications of this type of surgery?
Major surgery such as Knee Replacement is a serious consideration in the elderly and carries a surgical risk even in someone without PD. The addition of chronic disease increases the risk overall of perioperative complications, such as slower recovery times, mental status changes, and pneumonia.
Parkinson's disease symptoms often worsen when there is another stressor occurring with the physical or emotional health of the individual. It is like a "barometer" of what is happening with the patient. Major surgery is a significant stressor and so, often, worsening of PD symptoms occurs after the procedure. This is likely due to many reasons including the surgical stress, the inactivity, the change in routine, additional medications, and changes in the pattern of PD medications during the perioperative period.
In some patients this worsening becomes a permanent "lowering of the baseline state." In others, overtime, recovery back to presurgical control is seen. Certainly age and other health problems play a role in increasing the risk of worsening this baseline. Early activity soon after surgery such as aggressive therapy can play a role in speeding recovery. Medication adjustment may be necessary in the perioperative period. Due to other medications being used during this period, such as pain medicine, cognitive function may become impaired. Limiting the use of narcotics and sedatives if possible can lessen the chance of this.
Preparation before surgery is the best defense. Starting an exercise or therapy program before and being dedicated to being aggressive with a rehabilitation program after surgery is very important.
Finally, getting a thorough examination by the internist to make certain there are no other health issues that might complicate the surgery is a must.
Karen M Thomas, DO
College of Medicine
The Ohio State University