Parkinson's Disease Plays Havoc With Common Orthopaedic Conditions

Although Parkinson's disease (PD) is a neurological disorder, according to an article in the January 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons, the disease also increases a person's risk of experiencing complicated orthopaedic conditions. The author recommends that all Parkinson's treatment plans include a multidisciplinary approach in order to address additional accompanying musculoskeletal health issues.

According to the author Dr. Lee Zuckerman, M.D., chief resident of orthopaedic surgery, Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center in Brooklyn, New York, tremors, body rigidity, and problems with movement caused by PD may lead to other secondary, medical issues. One often-noted example relates to the fact that people with Parkinson's often move and walk less than non-suffers and generally stay indoors.

Decreased movement may lead to bone loss, and the reduced exposure to sunlight that generally occurs when patients spend little time outdoors is likely to generate a decrease in vitamin D, which is needed to keep bones strong. This is particularly harmful to Parkinson's patients, since the combination of decreased bone density and instability from tremors and rigidity caused by PD greatly increase a person's risk of:

Falling

Breaking bones

Osteoporosis

Ensuring family members are involved in care can have a positive impact on patient health. Dr. Zuckerman says, "I recommend patients and their families read up on Parkinson's disease so they can prepare themselves for the challenges that come with it. This type of early education is important, because it can prevent these secondary problems from occurring. For instance checking bone mineral density and getting treatment for at-risk patients can help reduce the risk of fracture."

Recommended actions to prevent orthopaedic problems in Parkinson's disease include:

Bone density

Physical therapy

Vitamin therapy

Medication to increase bone density

Optimizing therapies for gait and rigidity

The author recommends that patients with PD who are being treated by an orthopaedic surgeon should also be treated by a medical team that includes a neurologist, a neurosurgeon, a primary care physician, a physical medicine and rehabilitation physician, and a social worker. Including family members can ease the complexity of care by ensuring the patient is seeing the correct doctors while getting referrals to other members of the multidisciplinary team.

Although there are surgical treatments for orthopaedic conditions experienced by people with PD, the disease can have a negative effect on recovery. In one example, the tremors associated with PD have been shown to interfere with the repair and rehabilitation of bone injuries. Those who have had a joint replacement are often relieved of pain and initially have improvements in mobility, but these improvements only last about a year.

Dr. Zuckerman comments: "Whether this is because the disease is progressing or because the rehabilitation was insufficient is unclear. So patients now have to decide what they want to accomplish -- more mobility or decreased pain. They have to know that although their pain level should improve, their function may get worse after a year."

Treatments for PD patients have allowed them to live longer lives with improved quality of life. As these patients age, there are strong predictions that there will be an increased need for medical and surgical interventions for complicated orthopaedic issues.

Disclosure: Neither Dr. Zuckerman nor a member of his immediate family, has received anything of value from, or owns stock in, a commercial company or institution related directly or indirectly to the subject of this article.

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Measuring Device Aims to Boost Hip Operation Success

Researchers at the National Institute of Standards and Technology (NIST) are developing state-of-the-art measuring techniques, similar to those used in making aerospace components fit together precisely, that soon could improve success rates for hip replacement surgery.

At the request of a group of prominent orthopaedic surgeons and the American Academy of Orthopaedic Surgeons (AAOS), NIST researchers are working to improve calibrations and operating room testing of the Computer Assisted Orthopaedic Surgery (CAOS) tracking instruments surgeons use to plan the delicate, highly complex operation.

To be completely successful, CAOS hip replacement surgery must take into account tiny human skeletal differences. Imprecise measurements, which could result from conditions seemingly unrelated to the surgery, such as operation room noise or temperature, can lead to poor positioning of implants, leaving some former patients with discomfort during walking and, in rarer cases, a need to redo the operation.

The researchers have built a lightweight device called a “phantom” that resembles the artificial socket, ball and femur substitutes that surgeons use to replace the joint and bone in hip operations, based on a calibrated XY coordinate frame. They drilled tiny holes at precisely measured intervals into the phantom and made cuts at precisely measured angles, favored by surgeons for CAOS operations. Because the precise coordinates of the mechanical (magnetic) ball and socket joint center of rotation have been measured, manufacturers of CAOS tracking sensors can use the phantom to test the accuracy of their measuring instruments. Surgeons also should be able to test the accuracy of their CAOS devices, just before making their first incision, to measure ball and socket joint center of rotation coordinates, angles for cuts into the bone and places for the insertion of screws.

Currently, no standardized approach to the evaluation of CAOS technology exists, but an ASTM International committee is working on the establishment of such standards.

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