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Full knee replacement


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#1 joebestglf

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Posted 29 June 2011 - 10:44 AM

I am 65 years old and have had Parkinson's and been treated with sinemet for 2 years. I had my right knee replaced pre-Pakinson's. Now I am having so much pain with the left knee that it needs to be replaced. Having done this once, I have a good understanding of the post-op pain and the rehab. What questions should I be asking the surgeon? I don't want to be in a position where the surgery was a success but due to stress of the surgery itself, inability to do proper rehab, managing Parkinson's meds and pain meds and other factors that I end up worse off and have accelerated the Parkinso's process. Thank you

#2 Dr. Okun

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Posted 29 June 2011 - 02:56 PM

For anaesthesia, the lighter the sedation the better (local over general if possible). Keep on PD meds post-op and in rehab. Let the neurologist know and be ready to call he/she for problems. Be sure the hospital understands dosing and timing make a difference. Watch out for urinary infections and antibiotics. Some patients worsen post-op so be ready to rebound!


Here are two recent articles we have written at NPF on the subject:


1. Parkinsonism Relat Disord. 2011 Jul;17(6):440-5. Epub 2011 Apr 1.

Hospitalization in Parkinson disease: A survey of National Parkinson Foundation
Centers.

Chou KL, Zamudio J, Schmidt P, Price CC, Parashos SA, Bloem BR, Lyons KE,
Christine CW, Pahwa R, Bodis-Wollner I, Oertel WH, Suchowersky O, Aminoff MJ,
Malaty IA, Friedman JH, Okun MS.

Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department
of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.

OBJECTIVES: To explore current practices and opinions regarding hospital
management of Parkinson disease (PD) patients in specialized PD Centers.
METHODS: Fifty-one out of 54 National Parkinson Foundation (NPF) Centers
worldwide completed an online survey regarding hospitalization of PD patients.
RESULTS: Many Centers were concerned about the quality of PD-specific care
provided to their patients when hospitalized. Primary concerns were adherence to
the outpatient medication schedule and poor understanding by hospital staff of
medications that worsen PD. Few Centers had a policy with their primary hospital
that notified them when their patients were admitted. Rather, notification of
hospitalization came often from the patient or a family member. Several Centers
(29%) reported not finding out about a hospitalization until a routine clinic
visit after discharge. Quick access to outpatient PD care following discharge was
a problem in many Centers. Elective surgery, fall/fracture, infection, and mental
status changes, were identified as common reasons for hospitalization.
CONCLUSIONS: There is a perceived need for PD specialists to be involved during
hospitalization of their patients. Improvement in communication between hospitals
and PD Centers is necessary so that hospital clinicians can take advantage of PD
specialists' expertise. Education of hospital staff and clinicians regarding
management of PD, complications of PD, and medications to avoid in PD is
critical. Most importantly, outpatient access to PD specialists needs to be
improved, which may prevent unnecessary hospitalizations in these patients.


PMID: 21458353 [PubMed - in process]


2. Parkinsonism Relat Disord. 2011 Mar;17(3):139-45. Epub 2010 Dec 14.

Management of the hospitalized patient with Parkinson's disease: current state of
the field and need for guidelines.

Aminoff MJ, Christine CW, Friedman JH, Chou KL, Lyons KE, Pahwa R, Bloem BR,
Parashos SA, Price CC, Malaty IA, Iansek R, Bodis-Wollner I, Suchowersky O,
Oertel WH, Zamudio J, Oberdorf J, Schmidt P, Okun MS; National Parkinson
Foundation Working Group on Hospitalization in Parkinson's Disease.

National Parkinson Foundation Center of Excellence, University of California San
Francisco, Neurology Department, CA, USA.

OBJECTIVE: To review the literature and to identify practice gaps in the
management of the hospitalized Parkinson's disease (PD) patient.
BACKGROUND: Patients with PD are admitted to hospitals at higher rates, and
frequently have longer hospital stays than the general population. Little is
known about outpatient interventions that might reduce the need for
hospitalization and also reduce hospital-related complications.
METHODS: A literature review was performed on PubMed about hospitalization and PD
between 1970 and 2010. In addition, in press peer-reviewed papers or published
abstracts known to the authors were included. Information was reviewed by a
National Parkinson Foundation workgroup and a narrative review article was
generated.
RESULTS: Motor disturbances in PD are believed to be a causal factor in the
higher rates of admissions and complications. However, other conditions are
commonly recorded as the primary reason for hospitalization including motor
complications, reduced mobility, lack of compliance, inappropriate use of
neuroleptics, falls, fractures, pneumonia, and other important medical problems.
There are many relevant issues related to hospitalization in PD. Medications,
dosages and specific dosage schedules are critical. Staff training regarding
medications and medication management may help to avoid complications,
particularly those related to reduced mobility, and aspiration pneumonia.
Treatment of infections and a return to early mobility is also critical to
management.
CONCLUSIONS: Educational programs, recommendations, and guidelines are needed to
better train interdisciplinary teams in the management of the PD patient. These
initiatives have the potential for both cost savings and improved outcomes from a
preventative and a hospital management standpoint.


PMCID: PMC3070297
PMID: 21159538 [PubMed - indexed for MEDLINE]
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips




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