Using Data to Predict Adverse TKA Events in Parkinson’s Patients

A recent retrospective study looked at 558,371 total knee arthroplasty (TKA) patients—3,082 with Parkinson's Disease and 555,289 without the condition. Their work, “Complications During the Hospital Stay, Length of Stay, and Cost of Care in Parkinson Patients Undergoing Total Knee Arthroplasty: A Propensity Matched Database Study,” appears in the July 8, 2022, edition of the Journal of the American Academy of Orthopaedic Surgeons Global Research & Reviews.

Study co-author, Naga Suresh Cheppalli, M.D., an orthopedic surgeon at the University of New Mexico School of Medicine, explained the genesis of this study to OTW, “With the introduction of outpatient total joint care, bundled payment, and enhanced recovery pathways following joint replacement, it is quite important for surgeons and patients to choose the correct setting for surgery and post-operative care. Reducing the cost drivers and avoiding complications with successful outcomes is the current goal of joint arthroplasty in the era of bundled care payment pathways.”

“In the future, we anticipate a significantly increased number of TKA in patients suffering from Parkinson's Disease. This study data helps surgeons and patients predict their complications while they are in the hospital and choose the setting of their care.”

“Our team found an increased incidence of complications such as acute blood loss anemia, periprosthetic mechanical complications, and increased COS [cost of care], but no difference in length of stay (LOS) was noted in patients undergoing TKA with Parkinson’s Disease,” stated Dr. Cheppalli to OTW. “This information can be useful to make an informed decision regarding patient care and the preferred healthcare setup for TKA in patients with Parkinson’s Disease.”

Specifically, the incidence rate of blood loss anemia in the Parkinson’s group was 22.3% versus 13.5% in the control group of 13.5%; the incidence rate of periprosthetic dislocations was 1.5% in the Parkinson's group versus 0.4% in the control group; and, finally, the incidence rates of periprosthetic mechanical complications including but not limited to periprosthetic fractures, knee dislocations, patellar maltracking, and subluxations was 1.1% in the Parkinson's group versus 0.6% in the control group.

A True Patient Champion and Lessons Learned

According to Cheppalli, “This study gave me insights regarding the complication profile and cost of care associated with joint arthroplasty in patients with Parkinson’s Disease. Using this information, I will be more prepared to tackle those specific problems like having blood available in the immediate post-operative period (increased incidence of acute blood loss anemia) and having constrained implants available (to avoid mechanical complications).”

“Patients with Parkinson’s Disease are a special group of total joint arthroplasty patients and their cost of care can be higher. I negotiate with insurance for an additional payment plan (other than being covered in bundled care plan) while taking care of medically complex patients. With the mandatory bundled payments, there are no provisions for this kind of additional reimbursement, there is a risk that these patients could be deprived of the benefits of life-improving surgeries like TKA.”