PDF(Pubmed)
Abstract：
BACKGROUND: Patients with Parkinson\'s disease have a high dislocation rate after total hip arthroplasty (THA). This study describes a case with severe Parkinson\'s disease who developed rapidly destructive coxarthrosis (RDC) and underwent THA using a dual mobility cup after a levodopa-carbidopa intestinal gel (LCIG) infusion.
METHODS: The patient is a 59-year-old female with a ten-year history of Parkinson\'s disease, which was first treated with oral levodopa. The patient developed RDC of the right hip joint. However, THA was difficult owing to Parkinson\'s disease and its treatment side effects, such as wearing-off, dyskinesia, and freezing of the gait, Thus, LCIG was initiated, and improvement in wearing-off and dyskinesia was observed. Two months after the LCIG therapy, the disease was controlled well. THA was subsequently performed using a dual mobility cup to prevent postoperative dislocation. Postoperatively, LCIG therapy was continuously administered to carefully manage the disease, which was controlled well with no increase in wearing-off and dyskinesia after surgery. At 1 year after surgery, the walking speed, stride length, and the Harris hip score improved compared to preoperatively. The UPDRS III motor score improved to eight without signs of wearing-off or dyskinesia. The Hoehn-Yahr scale was II in the \"on\" period and remained unchanged 1 year after surgery. The patient could walk without a cane and had satisfactory functional outcomes.
CONCLUSIONS: This case proved that LCIG treatment performed preoperatively, followed by THA using a dual mobility cup, and strict management of Parkinson\'s disease could result in a satisfactory clinical course without recurrence of wearing-off and dyskinesia. Similar procedures may benefit other patients with Parkinson\'s disease who have previously been deemed unsuitable for THA.
METHODS: The patient is a 59-year-old female with a ten-year history of Parkinson\'s disease, which was first treated with oral levodopa. The patient developed RDC of the right hip joint. However, THA was difficult owing to Parkinson\'s disease and its treatment side effects, such as wearing-off, dyskinesia, and freezing of the gait, Thus, LCIG was initiated, and improvement in wearing-off and dyskinesia was observed. Two months after the LCIG therapy, the disease was controlled well. THA was subsequently performed using a dual mobility cup to prevent postoperative dislocation. Postoperatively, LCIG therapy was continuously administered to carefully manage the disease, which was controlled well with no increase in wearing-off and dyskinesia after surgery. At 1 year after surgery, the walking speed, stride length, and the Harris hip score improved compared to preoperatively. The UPDRS III motor score improved to eight without signs of wearing-off or dyskinesia. The Hoehn-Yahr scale was II in the \"on\" period and remained unchanged 1 year after surgery. The patient could walk without a cane and had satisfactory functional outcomes.
CONCLUSIONS: This case proved that LCIG treatment performed preoperatively, followed by THA using a dual mobility cup, and strict management of Parkinson\'s disease could result in a satisfactory clinical course without recurrence of wearing-off and dyskinesia. Similar procedures may benefit other patients with Parkinson\'s disease who have previously been deemed unsuitable for THA.
摘要：
背景：帕金森病患者全髋关节置换术（THA）后脱位率高。这项研究描述了一个严重的帕金森氏病病例，该病例发展为快速破坏性的髋关节病（RDC），并在输注左旋多巴-卡比多巴肠凝胶（LCIG）后使用双活动杯进行了THA。
方法：患者是一名59岁的女性，有10年的帕金森病病史，首先用口服左旋多巴治疗。患者出现右髋关节RDC。然而,由于帕金森氏病及其治疗副作用，THA很困难，比如磨损，运动障碍,和冻结的步态，因此，LCIG已启动，并观察到磨损和运动障碍的改善。LCIG治疗后两个月,疾病控制得很好。随后使用双活动杯进行THA，以防止术后脱位。术后,持续进行LCIG治疗以谨慎管理疾病，控制良好，术后磨损和运动障碍没有增加。手术后1年,步行速度,步幅长度,Harris髋关节评分与术前相比有所改善。UPDRSIII运动评分提高到8分，没有磨损或运动障碍的迹象。Hoehn-Yahr量表在“开启”期为II，手术后1年保持不变。患者可以不用拐杖行走，并且具有令人满意的功能结果。
结论：该病例证明LCIG治疗术前有效，然后是使用双移动杯的THA，和帕金森氏病的严格管理可以导致一个令人满意的临床过程，而不会复发磨损和运动障碍。类似的手术可能会使以前被认为不适合THA的其他帕金森病患者受益。
方法：患者是一名59岁的女性，有10年的帕金森病病史，首先用口服左旋多巴治疗。患者出现右髋关节RDC。然而,由于帕金森氏病及其治疗副作用，THA很困难，比如磨损，运动障碍,和冻结的步态，因此，LCIG已启动，并观察到磨损和运动障碍的改善。LCIG治疗后两个月,疾病控制得很好。随后使用双活动杯进行THA，以防止术后脱位。术后,持续进行LCIG治疗以谨慎管理疾病，控制良好，术后磨损和运动障碍没有增加。手术后1年,步行速度,步幅长度,Harris髋关节评分与术前相比有所改善。UPDRSIII运动评分提高到8分，没有磨损或运动障碍的迹象。Hoehn-Yahr量表在“开启”期为II，手术后1年保持不变。患者可以不用拐杖行走，并且具有令人满意的功能结果。
结论：该病例证明LCIG治疗术前有效，然后是使用双移动杯的THA，和帕金森氏病的严格管理可以导致一个令人满意的临床过程，而不会复发磨损和运动障碍。类似的手术可能会使以前被认为不适合THA的其他帕金森病患者受益。
