Grete,
I had a total hip replacement in Sept., after a rapid onset and
progression of acute joint inflammation which wiped out the ball of my femur.
In a year and a half it went from normal for a woman of my age (50, at the
time), to deteriorated to the point that I could no longer walk. The
replacement held for two months, and then began to dislocate for the same
reasons your father's did. The muscle changes with rigidity, dyskenesia, and
dystonia made what appeared to be a stable joint unstable. Because of my
age, the fact that my PD has progressed slowly, and with regular exercise I
have stayed in good condition, the doctors misjudged my ability to heal with
a regular joint. After four dislocations, I had a second surgery in
December, and spent three months in a brace, which resulted in my hip and leg
muscles, already pretty damaged, to become completely atrophied. My PD has
pretty well held. It may be a little more unstable, and I have had to add
ativan to my pharmacopia, which I take from time to time. With the second
surgery the surgeon replaced the first socket with a "captured cup" which
secures the ball in the socket with a lip and wires. It has now been four
months. I am out of the brace, swimming, and keeping my fingers crossed.
The other thing is that the bone had not grown over the titatium at all when
they went in to replace the first joint. This needs to take place to secure
it.
I had no trouble with diorientation following surgery.
I do think that PD patients should be given the most secure joint
replacements, despite loss of range of motion. I have searched the medline,
and there is almost nothing written about this
In "Clinical Orthopedics and Related Research", in July 1990, an
article entitled, "Hip FRactures and Parkinson's Disease", By R, Turcotte,
M.D., et al. Their results showed a greater complication rate in patients
with hemiarthroplasty than by nailing.
In the "Archives of Physical Medical Rehabilitation" Nov. 1994, Fast A,
Mendelsohn E. and Sosner J. published a single case study . The title of
their article is "Total Knee Arthrorplsty in Parkinson's Disease". They
recommend beginning rehabilitation before the surgery and continuing after
with the knowledge that in PD patients the process is prolonged.
In April 1988 "Journal of Bone Joint Surgery", J.W. Staeheli, et al at
Mayo Clinic, in "Hip Fractures in Parkinsons Disease" , reported on
replacement of the femural head in forty-nine patients ages 47 to 92. They
reported only one dislocation, but only the ball, not the socket was
replaced.
I don't think there's anything or particularly useful in any of this.
I hope things work out with your father. It's extremely important to
keep active. Claudia Elliott
