Biomarkers of Muscle Damage Increased in Anterolateral Compared to Direct Lateral Approach to the Hip in Hemiarthroplasty: No Correlation with Clinical Outcome : Short-term Analysis of Secondary Outcomes from a Randomized Clinical Trial in Patients...

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2018 May 24

PMID 29789919

Citations 5

Authors

T O Ugland

G Haugeberg

S Svenningsen

S H Ugland

O H Berg

A H Pripp

L Nordsletten

Affiliations

Soon will be listed here.

Abstract

Introduction: To compare increase in serum creatine kinase (CK) and its association with functional outcome between the muscle-sparing anterolateral approach and the direct lateral approach to the hip in patients with displaced femoral neck fracture (FNF).

Methods: In this randomized trial, we enrolled eligible patients between 70 and 90 years of age with FNF. Patients were allocated to an uncemented hemiarthroplasty inserted through a direct lateral or an anterolateral approach. The primary endpoints were pain and patient satisfaction assessed by the Visual Analogue Scale (VAS). Among secondary endpoints was increase in CK at 24 and 48 h compared to baseline and its association with surgical parameters, Timed up and Go Test (TUG), Harris Hip Score (HHS), and the presence of a Trendelenburg sign using correlation analysis. This paper reports on increase in serum CK and its association with functional outcome.

Results: At 24 h, there was a mean increase from baseline in total CK of 228 U/L (95% CI 187 to 269; P < 0.001). There was a difference between groups at 24 h in CK increase with higher levels in the anterolateral group (mean difference 80 U/L; 95% CI - 0.5 to 162; P = 0.05). Likewise, at 48 h, there was a mean difference of 117 U/L (95% CI 22 to 212; P = 0.01). No correlation was found between CK values and functional assessments.

Conclusions: Compared with the direct lateral approach, the anterolateral approach yielded higher levels of postoperative CK. However, there was no correlation between levels of CK and functional outcome.

Trial Registration: ClinicalTrials.gov Identifier: NCT02028468.

Citing Articles

Less inflammatory response in the direct anterior than in the direct lateral approach in patients with femoral neck fractures receiving a total hip arthroplasty: exploratory results from a randomized controlled trial.

Hoseth J, Husby O, Lian O, Myklebust T, Aae T Acta Orthop. 2024; 95:440-445.

PMID: 39145606 PMC: 11325853. DOI: 10.2340/17453674.2024.41242.

Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis.

Filippini M, Bortoli M, Montanari A, Pace A, Di Prinzio L, Lonardo G Medicina (Kaunas). 2023; 59(7).

PMID: 37512031 PMC: 10385644. DOI: 10.3390/medicina59071220.

Approaches for Total Hip Arthroplasty: A Systematic Review.

Patel N, Golwala P Cureus. 2023; 15(2):e34829.

PMID: 36919077 PMC: 10008322. DOI: 10.7759/cureus.34829.

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery-A Scoping Review.

Buis N, Esfandiari H, Hoch A, Furnstahl P Front Surg. 2022; 8:771275.

PMID: 35155547 PMC: 8825480. DOI: 10.3389/fsurg.2021.771275.

High risk of positive Trendelenburg test after using the direct lateral approach to the hip compared with the anterolateral approach: a single-centre, randomized trial in patients with femoral neck fracture.

Ugland T, Haugeberg G, Svenningsen S, Ugland S, Berg O, Pripp A Bone Joint J. 2019; 101-B(7):793-799.

PMID: 31256660 PMC: 6617057. DOI: 10.1302/0301-620X.101B7.BJJ-2019-0035.R1.

References

Higuchi F, Gotoh M, Yamaguchi N, Suzuki R, Kunou Y, Ooishi K . Minimally invasive uncemented total hip arthroplasty through an anterolateral approach with a shorter skin incision. J Orthop Sci. 2003; 8(6):812-7. DOI: 10.1007/s00776-003-0715-x. View

Hardcastle P, Nade S . The significance of the Trendelenburg test. J Bone Joint Surg Br. 1985; 67(5):741-6. DOI: 10.1302/0301-620X.67B5.4055873. View

Sander K, Layher F, Anders C, Roth A, Babisch J, Scholle H . [Gait analysis after minimally invasive total hip arthroplasty]. Orthopade. 2012; 41(5):365-76. DOI: 10.1007/s00132-011-1891-6. View

Mjaaland K, Kivle K, Svenningsen S, Pripp A, Nordsletten L . Comparison of markers for muscle damage, inflammation, and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty: A prospective, randomized, controlled trial. J Orthop Res. 2015; 33(9):1305-10. DOI: 10.1002/jor.22911. View

Lombao Iglesias D, Bago Granell J, Vilor Rivero T . Validity of creatine kinase as an indicator of muscle injury in spine surgery and its relation with postoperative pain. Acta Orthop Belg. 2015; 80(4):545-50. View

Zawadsky M, Paulus M, Murray P, Johansen M . Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty. 2014; 29(6):1256-60. DOI: 10.1016/j.arth.2013.11.013. View

Smith L, Brunetz M, Chenier T, McCammon M, Houmard J, Franklin M . The effects of static and ballistic stretching on delayed onset muscle soreness and creatine kinase. Res Q Exerc Sport. 1993; 64(1):103-7. DOI: 10.1080/02701367.1993.10608784. View

Landgraeber S, Quitmann H, Guth S, Haversath M, Kowalczyk W, Kecskemethy A . A prospective randomized peri- and post-operative comparison of the minimally invasive anterolateral approach versus the lateral approach. Orthop Rev (Pavia). 2013; 5(3):e19. PMC: 3808794. DOI: 10.4081/or.2013.e19. View

Rykov K, Reininga I, Sietsma M, Knobben B, Ten Have B . Posterolateral vs Direct Anterior Approach in Total Hip Arthroplasty (POLADA Trial): A Randomized Controlled Trial to Assess Differences in Serum Markers. J Arthroplasty. 2017; 32(12):3652-3658.e1. DOI: 10.1016/j.arth.2017.07.008. View

10.

Apple F, Rhodes M . Enzymatic estimation of skeletal muscle damage by analysis of changes in serum creatine kinase. J Appl Physiol (1985). 1988; 65(6):2598-600. DOI: 10.1152/jappl.1988.65.6.2598. View

11.

Kumbhare D, Parkinson W, Dunlop B, Ryan E, Denkers M, Shah A . Biochemical measurement of muscle injury created by lumbar surgery. Clin Invest Med. 2007; 30(1):12-20. DOI: 10.25011/cim.v30i1.444. View

12.

Alecci V, Valente M, Crucil M, Minerva M, Pellegrino C, Sabbadini D . Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol. 2011; 12(3):123-9. PMC: 3163771. DOI: 10.1007/s10195-011-0144-0. View

13.

Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H . A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty. 2008; 24(5):698-704. DOI: 10.1016/j.arth.2008.04.012. View

14.

Ewen A, Stewart S, St Clair Gibson A, Kashyap S, Caplan N . Post-operative gait analysis in total hip replacement patients-a review of current literature and meta-analysis. Gait Posture. 2012; 36(1):1-6. DOI: 10.1016/j.gaitpost.2011.12.024. View

15.

Agten C, Sutter R, Dora C, Pfirrmann C . MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches. Eur Radiol. 2016; 27(3):1312-1321. DOI: 10.1007/s00330-016-4455-7. View

16.

Ugland T, Haugeberg G, Svenningsen S, Ugland S, Berg O, Pripp A . Less periprosthetic bone loss following the anterolateral approach to the hip compared with the direct lateral approach. Acta Orthop. 2017; 89(1):23-28. PMC: 5810828. DOI: 10.1080/17453674.2017.1387730. View

17.

Suzuki K, Kawachi S, Sakai H, Nanke H, Morita S . Mini-incision total hip arthroplasty: a quantitative assessment of laboratory data and clinical outcomes. J Orthop Sci. 2005; 9(6):571-5. DOI: 10.1007/s00776-004-0830-3. View

18.

Podsiadlo D, Richardson S . The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39(2):142-8. DOI: 10.1111/j.1532-5415.1991.tb01616.x. View

19.

Goutallier D, Postel J, Bernageau J, Lavau L, Voisin M . Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994; (304):78-83. View

20.

Harris W . 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(4):737-55. View