Is Parkinson Disease a Risk Factor After Total Elbow Arthroplasty? Midterm Survivorship in a Matched Cohort.

PURPOSE: Parkinson disease (PD) has been associated with elevated rates of periprosthetic fracture, periprosthetic joint infection, and reduced implant survivorship following total hip and knee arthroplasty; however, it remains unclear whether these risks extend to total elbow arthroplasty (TEA). The purpose of this study was to evaluate whether PD is associated with worse midterm survivorship and higher complication risk after TEA compared with matched controls.

METHODS: A retrospective, matched cohort study was performed using the PearlDiver administrative claims database. Adult patients undergoing primary TEA were identified, and PD was defined by diagnostic claims recorded on or before the index procedure. Patients with PD were matched 1:4 to non-PD controls by age and sex. Primary end points were aseptic loosening, periprosthetic joint infection, and periprosthetic fracture. Secondary outcomes included revision TEA, operative fixation of periprosthetic fracture, and a composite adverse outcome defined as the first occurrence of any complication or reoperation. Patients were followed until first event, end of enrollment, or 5 years. Kaplan-Meier analysis was used to estimate event-free survivorship, with log-rank testing and Cox proportional hazards regression used for comparison.

RESULTS: After matching, 675 patients were included: 135 with PD and 540 controls. Overall adverse events were uncommon, and survivorship remained high across all end points. There was no significant difference in 5-year composite adverse event-free survivorship between PD and controls (84.4% [95% CI: 77.9-91.4] vs 83.4% [95% CI: 79.9-87.0]; log-rank P = .69). Loosening-free survivorship was also similar between groups at 5 years (96.4% [95% CI: 92.9-100] in PD vs 95.7% [95% CI: 93.7-97.8] in controls; P = .68). No significant differences were observed in survivorship for periprosthetic joint infection or periprosthetic fracture. The study had approximately 80% power to detect a hazard ratio of about 2.0 for adverse events; smaller differences may have gone undetected.

CONCLUSIONS: Parkinson disease was not associated with worse 5-year survivorship or higher risk of implant-threatening complications after TEA. These findings suggest that PD diagnosis alone may not confer increased midterm risk following TEA.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III, retrospective matched cohort study.