Does Parkinson's disease increase the risk of adverse outcomes in patients undergoing total hip arthroplasty? A systematic review and meta-analysis.

BACKGROUND

Parkinson's disease (PD) is usually considered a contraindication for total hip arthroplasty (THA). While several studies have reported their experience of THA in PD patients, a detailed and updated quantitative synthesis is lacking. Previous reviews have combined single-arm and case-control studies or included a limited number of studies. We conducted this updated systematic review and meta-analysis to answer the following clinical query: Does PD increase the risk of complications in patients undergoing THA?

METHODS

We searched PubMed, Embase, Web of Science, and Scopus from their inception until July 15, 2025, for studies comparing complications (mortality, prosthetic joint infection, revision, fracture, aseptic loosening, dislocation, and readmission) of PD and non-PD patients undergoing THA. The DerSimonian and Laird random-effects meta-analysis model was then used to generate pooled odds ratio (OR) with 95% confidence intervals (CI) for each complication. Cochran's Q statistic and the I2 index were used to assess heterogeneity between studies. Sensitivity analysis was conducted by sequentially excluding one study at a time from the meta-analysis. Risk of bias was assessed using the Newcastle Ottawa Scale.

RESULTS

Ten studies were included. Meta-analysis showed that the presence of PD significantly increased the risk of medical (OR: 1.44 95% CI: 1.02, 2.03 I2 = 57%) and surgical complications (OR: 1.61 95% CI: 1.03, 2.52 I2 = 42%) in PD patients. Meta-analysis demonstrated that the presence of PD significantly increased the risk of dislocation (OR: 1.97 95% CI: 1.45, 2.68 I2 = 0%), mortality (OR: 2.86 95% CI: 1.75, 4.68 I2 = 86%), and revision (OR: 2.42 95% CI: 1.56, 3.74 I2 = 71%). The risk of fracture (OR: 4.12 95% CI: 0.82, 20.7 I2 = 75%), prosthetic joint infection (OR: 1.38 95% CI: 0.44, 4.29 I2 = 50%), and aseptic loosening (OR: 3.31 95% CI: 0.89, 12.28 I2 = 9%) was increased but the effect size was not statistically significant.

CONCLUSIONS

Patients with PD undergoing THA may have a significantly higher risk of medical and surgical complications. Specifically, the risk of dislocation, revision surgery and mortality seems to be significantly increased in patients with PD as compared to controls. There was also a tendency of increased risk of aseptic loosening, fracture, and PJI in PD patients but the summary estimates did not achieve statistical significance.

LEVEL OF EVIDENCE: III.