Is the Parkinson Disease Diagnosis-to-Surgery Interval Associated With 5-year Vascular and Periprosthetic Outcomes After TKA? A Nationwide Large-database Study
Clinical Orthopaedics and Related Research · 6 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Parkinson disease is increasingly common among older TKA candidates, so knowing that its main long-term association is a modest rise in stroke-type events, not fracture or infection, helps frame preoperative counselling.
The evidence
This South Korean nationwide insurance-database study compared about 20,700 TKA patients with Parkinson disease diagnosed before surgery against propensity-matched TKA patients without Parkinson disease, tracking stroke-type (cerebrovascular) events, heart (cardiovascular) events, periprosthetic fracture, and prosthetic joint infection over 5 years. Parkinson disease was linked to a small rise in cerebrovascular events (adjusted HR 1.11, 95% CI 1.07 to 1.16), and the vascular signal appeared mainly in patients diagnosed 5 years or less before TKA. Periprosthetic fracture and infection were not higher.
5-year cerebrovascular events: Hazard ratio 1.11 (95% CI 1.07 to 1.16; ratio). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Registry cohort (adjusted)Design starting point: 37.4
Raised the score
- Post-adjustment balance demonstrated+4.3
- Competing risks handled+4.3
Lowered the score
- Exposure defined after cohort entry (immortal time bias)−11.9
Score capped at 25. Immortal time bias: exposure was defined after cohort entry.
Methods at a glance
Recorded assessment- Confounding adjustmentPropensity scores
- Covariate balance confirmedMet
- Outcome assessors blindedNot reported
- Comparable start of follow-upNot met
- Adequate statistical powerNot reported
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 37.4
- Post-adjustment balance demonstrated
- +4.3
- Exposure defined after cohort entry (immortal time bias)
- −11.9
- 60-month follow-up
- +3.4
- Competing risks handled
- +4.3
- Journal prior (not an observed method)
- +2.2
- Methodological cap
- −14.6
- Final rigour score rounded
- 25 / 100
Study design sets the starting point and a ceiling of 80. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.How should you counsel a patient diagnosed with Parkinson disease 2 years ago about stroke risk and expected implant complications before TKA, given an adjusted HR of about 1.1?
2.Which Parkinson disease patients, if any, should be referred for neurology, anaesthesia, or medicine review of blood pressure instability and medication management before TKA, and which should proceed without extra workup?
Original publication title
Is the Parkinson Disease Diagnosis-to-Surgery Interval Associated With 5-year Vascular and Periprosthetic Outcomes After TKA? A Nationwide Large-database Study