title: Shoulder arthroplasty in patients with Parkinson's disease is associated with increased complications.
abstract: BACKGROUND
  Case series suggest a higher postoperative complication rate after shoulder arthroplasty in patients with Parkinson's disease (PD). The purpose of this study was to evaluate the perioperative complications in patients with PD undergoing conventional total shoulder arthroplasty (TSA), reverse shoulder arthroplasty (RSA), and shoulder hemiarthroplasty (HA).
  
  
  METHODS
  Patients with PD who underwent TSA, RSA, or HA were identified in a national insurance database and then matched to controls without a diagnosis of PD based on age, gender, obesity, diabetes, and tobacco use. Complications were assessed, including infection, dislocation, revision, stiffness, fracture, component loosening, and systemic complications.
  
  
  RESULTS
  The final study cohorts included 3390 TSA patients with PD and 47,034 matched TSA controls; 809 RSA patients with PD and 14,262 matched controls; and 2833 HA patients with PD and 38,850 matched controls. PD was associated with significant higher rates of infection (odds ratio [OR], 1.5, 1.7, 1.5, respectively), dislocation (OR, 2.5, 2.0, 2.8, respectively), revision arthroplasty (OR, 1.7, 1.8, 1.4, respectively), and systemic complications (OR, 1.4, 1.7, 1.3, respectively) after all 3 types of shoulder arthroplasty and with higher rates of periprosthetic fracture after conventional TSA (OR, 1.5) and shoulder HA (OR, 1.5). Component loosening was also more commonly noted in patients with PD after conventional TSA (OR, 1.5) and HA (OR, 1.9).
  
  
  CONCLUSIONS
  PD is associated with increased rates of infection, dislocation, revision shoulder arthroplasty, fracture, component loosening, and systemic complications after conventional TSA, RSA, and shoulder HA.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: M Tyrrell
authors.initials: MT
authors.lastname: Burrus
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Jourdan M
authors.initials: JM
authors.lastname: Cancienne
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: F Winston
authors.initials: FW
authors.lastname: Gwathmey
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA. Electronic address: sfb2e@virginia.edu.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Brockmeier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D012086:Reoperation; D012783:Shoulder Dislocation / Q000453:epidemiology; D012785:Shoulder Joint / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: Parkinson's disease; Shoulder arthroplasty; complication; dislocation; infection; loosening; revision; stiffness