The relationship between skeletal muscle serum markers and primary THA: a pilot study

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.

Fig. 1

The graph shows hemoglobin (g/dL) versus time (hours). The normal range (12.0–16.0 g/dL) is highlighted by the shaded overlay. MIS = minimally invasive surgery; WJ = modified Watson Jones.

Fig. 2

Hematocrit (%) versus time (hours) is shown in this graph. The normal range (37.0%–47.0%) is highlighted by the shaded overlay. MIS = minimally invasive surgery; WJ = modified Watson Jones.

Fig. 3

The graph shows creatine kinase (CK; ng/mL) versus time (hours). The normal range (0.2–4.8 ng/mL) is highlighted by the shaded overlay. MIS = minimally invasive surgery; WJ = modified Watson Jones.

Fig. 4

Creatine phosphokinase (U/L) versus time (hours) is shown. The normal range (38–174 U/L) is highlighted by the shaded overlay. MIS = minimally invasive surgery; WJ = modified Watson Jones.

Fig. 5

The graph shows serum myoglobin (ng/mL) with time. The normal range (0.5–70.0 ng/mL) is highlighted by the shaded overlay. MIS = minimally invasive surgery; WJ = modified Watson Jones.