Risk factors and functional outcomes of surgical treatment of fall-related hip fractures in patients with Parkinson’s disease

Abstract

urpose: One of the cardinal symptoms of Parkinson’s disease (PD) is represented by postural instability and disturbed balance which can cause frequent falls in these patients. Indeed, the increased risk of falling in combination with osteoporosis puts PD patients at high risk for hip osteoporotic fractures. This study was aimed to evaluate the potential risk factors associated with fall-related hip fracture in individual with PD and 2) to determine the impact of the disease on the perioperative course and functional outcome of these fractures. Materials and methods: From 2005 to 2016, 209 patients (98 males and 111 females, aged >65 years) with a definitive diagnosis of idiopathic parkinsonism were enrolled in this multicenter retrospective study. From these patients, 123 sustained falling, while 86 did not. From the patients who sustained a fall, 41 patients sustained a hip fracture and were surgically treated with either internal fixation or hip hemiarthroplasty. The recorded clinical features were age, disease duration, falls, and type fracture. The risk of fall was assessed by Morse fall scale. According to the scores of the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr staging(H&Y) we graded the PD severity. Osteoporosis was diagnosed using bone mineral density (BMD). The pre-fracture Barthel Index (BI) and Timed Up and Go test (TUG) were used to assess the functional status. In order to compare parameters that determine the functional result, was included a reference group of 40, sex- and age-matched, patients. This group comprised of individuals without intake of anti-parkinson medication. The perioperative complications and the in-hospital mortality were both reported. Results: The mean follow-up was 24-months. In this study, the percentage of falls was 58.8%, while the percentage of osteoporosis between patients with and without falls were respectively 33.3% (42/123) and 15.4% (13/86). 74 patients had fall-related fractures. Statistical analysis of the clinical manifestations and functional score findings between the PD patients with fall-related fractures and PD patients without fracture, revealed that sex (p = 0.001), mean Morse fall scale (p < 0.0001) and Hoehn and Yahr stage (p = 0.009) were significant variables. Regarding the functional outcome, no significant differences were observed between the groups [BI (p = 0.21) and TUG (p = 0.89)]. At the final follow-up, in patients with PD who were surgically treated for a fall-related hip fracture compare to patients without PD, the functional outcome was reduced according to Barthel Index (p = 0.001). Urinary tract infection was the more frequent perioperative complication. Post-operative pneumonia is another frequent complication, occurred in 5.5% of our series. 8 of 41 patients developed a pressure sore, while 1 patient with femoral neck fracture suffered a dislocation and underwent revision surgery. The mean length of hospital stay for Parkinson’s disease patients was 14 days, while patients without PD were staying 9 days.The in-hospital mortality rate for all patients was 4.3 %. Conclusions: Female sex, and advanced stage of PD and a higher mean Morse fall scale are associated with higher risk of fall-related hip fractures. Patients with PD who suffered a hip fracture are inclined to a longer hospital stay and a higher risk of complications. However, Parkinson’s disease does not represent a risk factor for a higher mortality or an inferior functional result, but in these patients, after 2-years follow-up, the functional outcome was reduced according to Barthel Index.