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The Relationship Between Skeletal Muscle Serum Markers and Primary THA: A Pilot Study

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Clinical Orthopaedics and Related Research®

Abstract

Various reports confirm elevations in serum markers associated with skeletal muscle injury after orthopaedic surgery in the absence of overt clinical manifestations of myocardial injury. We therefore measured the influence surgical approach has on these serum markers after primary THA. We nonrandomly enrolled 30 nonconsecutive patients undergoing THA in three groups of 10 based on current surgical approaches used at our facility: (1) minimally invasive (MIS) modified Watson Jones approach; (2) miniposterior transmuscular approach (MIS-I); and (3) MIS-II incision. Blood samples for hemoglobin, hematocrit, cardiac troponin I, total creatine kinase, creatine phosphokinase, and serum myoglobin were obtained the morning before surgery as a baseline, immediately postoperatively, and 72 hours thereafter. We found reproducible trends in serum enzyme levels consistent with skeletal muscle damage resulting from primary THA. Troponin I remained normal in all but one patient indicating no myocardial contribution to measured serum enzyme levels. All three procedures resulted in similar trends in serum enzyme markers relevant to primary THA. Our preliminary data suggest no surgical approach appears to affect the degree of muscle trauma more or less than another.

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References

  1. Alzeer AH, el-Hazmi MA, Warsy AS, Ansari ZA, Yrkendi MS. Serum enzymes in heat stroke: prognostic implication. Clin Chem. 1997;43:1182–1187.

    PubMed  CAS  Google Scholar 

  2. Berger RA. Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop Relat Res. 2003;429:232–241.

    Google Scholar 

  3. Berger RA. Mini-incision total hip replacement using an anterolateral approach: technique and results. Orthop Clin North Am. 2004;35:143–151.

    Article  PubMed  Google Scholar 

  4. Berger RA. Minimally invasive THR using two incisions. Orthopedics. 2004;27:382–383.

    PubMed  Google Scholar 

  5. Berger RA, Duwelius PJ. The two-incision minimally invasive total hip arthroplasty: technique and results. Orthop Clin North Am. 2004;35:163–172.

    Article  PubMed  Google Scholar 

  6. Berger RA, Jacobs JJ, Meneghini RM, Della VC, Paprosky W, Rosenberg AG. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res. 2004;429:239–247.

    Article  PubMed  Google Scholar 

  7. Berger RA, Sanders S, D’Ambrogio E, Buchheit K, Deirmengian C, Paprosky W, la Valle CJ, Rosenberg AG. Minimally invasive quadriceps-sparing TKA: results of a comprehensive pathway for outpatient TKA. J Knee Surg. 2006;19:145–148.

    PubMed  Google Scholar 

  8. Berry DJ, Berger RA, Callaghan JJ, Dorr LD, Duwelius PJ, Hartzband MA, Lieberman JR, Mears DC. Minimally invasive total hip arthroplasty: development, early results, and a critical analysis. J Bone Joint Surg Am. 2003;85:2235–2246.

    PubMed  Google Scholar 

  9. de Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BG, Drenth JP. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med. 2003;29:1121–1125.

    Article  PubMed  Google Scholar 

  10. Fehring TK, Mason JB. Catastrophic complications of minimally invasive hip surgery: a series of three cases. J Bone Joint Surg Am. 2005;87:711–714.

    Article  PubMed  Google Scholar 

  11. Feinfeld DA, Cheng JT, Beysolow TD, Briscoe AM. A prospective study of urine and serum myoglobin levels in patients with acute rhabdomyolysis. Clin Nephrol. 1992;38:193–195.

    PubMed  CAS  Google Scholar 

  12. Fransen EJ, Diris JH, Maessen JG, Hermens WT, van Dieijen-Visser MP. Evaluation of ‘new’ cardiac markers for ruling out myocardial infarction after coronary artery bypass grafting. Chest. 2002;122:1316–1321.

    Article  PubMed  Google Scholar 

  13. Goldstein WM, Branson JJ, Berland KA, Gordon AC. Minimal-incision total hip arthroplasty. J Bone Joint Surg Am. 2003;85(suppl 4):33–38.

    PubMed  Google Scholar 

  14. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.

    PubMed  CAS  Google Scholar 

  15. Hartzband MA. Posterolateral minimal incision for total hip replacement: technique and early results. Orthop Clin North Am. 2004;35:119–129.

    Article  PubMed  Google Scholar 

  16. Healey JH, Kagen LJ, Velis KP, Levine DB. Creatine kinase MB in skeletal muscle and serum of spine-fusion patients. Clin Orthop Relat Res. 1985;195:282–288.

    PubMed  Google Scholar 

  17. Jules-Elysee K, Urban MK, Urquhart B, Milman S. Troponin I as a diagnostic marker of a perioperative myocardial infarction in the orthopedic population. J Clin Anesth. 2001;13:556–560.

    Article  PubMed  CAS  Google Scholar 

  18. Kawaguchi Y, Matsui H, Gejo R, Tsuji H. Preventive measures of back muscle injury after posterior lumbar spine surgery in rats. Spine. 1998;23:2282–2287.

    Article  PubMed  CAS  Google Scholar 

  19. Kodatsch I, Finsterer J, Stollberger C. Serum creatine kinase elevation in a medical department. Acta Med Austriaca. 2001;28:11–15.

    Article  PubMed  CAS  Google Scholar 

  20. Laurence AS. Serum myoglobin and creatine kinase following surgery. Br J Anaesth. 2000;84:763–766.

    PubMed  CAS  Google Scholar 

  21. Lenke LG, Bridwell KH, Jaffe AS. Increase in creatine kinase MB isoenzyme levels after spinal surgery. J Spinal Disord. 1994;7:70–76.

    Article  PubMed  CAS  Google Scholar 

  22. Malinoski DJ, Slater MS, Mullins RJ. Crush injury and rhabdomyolysis. Crit Care Clin. 2004;20:171–192.

    Article  PubMed  Google Scholar 

  23. McCord J, Nowak RM, Hudson MP, McCullough PA, Tomlanovich MC, Jacobsoen G, Tokarski G, Khoury N, Weaver WD. The prognostic significance of serial myoglobin, troponin I, and creatine kinase-MB measurements in patients evaluated in the emergency department for acute coronary syndrome. Ann Emerg Med. 2006;42:343–350.

    Article  Google Scholar 

  24. Neill F, Sear JW, French G, Lam H, Kemp M, Hooper RJ, Foex P. Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients. Anaesthesia. 2000;55:641–647.

    Article  PubMed  CAS  Google Scholar 

  25. Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O’Brien S, Beverland D. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes: a prospective, randomized, controlled trial. J Bone Joint Surg Am. 2005;87:701–710.

    Article  PubMed  Google Scholar 

  26. Sculco TP. Less invasive total hip arthroplasty. Am J Orthop. 2006;35:217.

    PubMed  Google Scholar 

  27. Sculco TP, Jordan LC, Walter WL. Minimally invasive total hip arthroplasty: the Hospital for Special Surgery experience. Orthop Clin North Am. 2004;35:137–142.

    Article  PubMed  Google Scholar 

  28. Ward MM. Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med. 1988;148:1553–1557.

    Article  PubMed  CAS  Google Scholar 

  29. Wenz JF, Gurkan I, Jibodh SR. Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics. 2002;25:1031–1043.

    PubMed  Google Scholar 

  30. Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg Am. 2004;86:1353–1358.

    PubMed  Google Scholar 

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Acknowledgments

We thank Andrea H. Robinson, CCRC, for assistance in collecting and organizing data presented in this article and Amy Parks for assistance in preparation of this manuscript.

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Authors and Affiliations

  1. Tucson Orthopaedic Institute, 2424 N Wyatt Drive, Tucson, AZ, 85712, USA

    Russell G. Cohen MD, Jay A. Katz MD & Nebojsa V. Skrepnik MD, PhD

Authors
  1. Russell G. Cohen MD
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  2. Jay A. Katz MD
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  3. Nebojsa V. Skrepnik MD, PhD
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Corresponding author

Correspondence to Russell G. Cohen MD.

Additional information

One or more of the authors (RGC, JAK) have received funding from Zimmer, Inc for this study.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Cohen, R.G., Katz, J.A. & Skrepnik, N.V. The Relationship Between Skeletal Muscle Serum Markers and Primary THA: A Pilot Study. Clin Orthop Relat Res 467, 1747–1752 (2009). https://doi.org/10.1007/s11999-009-0809-7

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  • DOI: https://doi.org/10.1007/s11999-009-0809-7

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