Effect of Parkinson's Disease on Hemiarthroplasty Outcomes After Femoral Neck Fractures

Background: The purpose of this study was to evaluate the outcomes following hemiarthroplasty (HA) for femoral neck fractures (FNFs) in patients with Parkinson's disease (PD) compared with patients without PD.

Methods: This was a retrospective review utilizing the Nationwide Readmissions Database, a national database incorporating inpatient hospitalization information. Using the Nationwide Readmissions Database, patients who underwent HA for FNF between 2010-2014 were identified. International Classification of Diseases, 9th Revision, codes were used to find a subset of patients with PD. Primary outcomes of interest included death, hospital readmission, periprosthetic fracture, postoperative dislocation, any revision surgery, and revision surgery for instability, fracture, or infection.

Results: There were a total of 7721 (4%) patients with PD. There was no difference in the risk of death or any postoperative complications during index hospitalization for these patients. However, PD patients had an increased risk of hospital readmission (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.02-1.26) and postoperative dislocation (OR = 2.10, 95% CI: 1.58-2.80) within 90 days of surgery. PD patients also had an increased risk of revision surgery for instability (OR = 2.20, 95% CI: 1.48-3.28), despite no difference in the risk of any revision surgery, revision surgery for fracture, or revision surgery for infection.

Conclusion: In this retrospective cohort study, PD patients who underwent a HA for FNF had a greater risk of postoperative dislocation and revision surgery for instability within 90 days. These findings are not only important to consider when managing these at-risk patients but also stress the need to allocate operative and postoperative resources to prevent and treat instability.

Level of evidence: 3 (Retrospective cohort study).