title: 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.
abstract: It is proposed that the use of biochemical markers for muscle damage and inflammation provides an objective measure on invasiveness in total hip arthroplasty. We analyzed levels of creatine kinase and C-reactive protein (CRP) after total hip arthroplasty in patients randomized to minimally invasive direct anterior approach or direct lateral approach, also recording consumption of pain medication and levels of pain postoperatively. Eighty-three patients were operated by the use of anterior approach and eighty using lateral. Creatine kinase and CRP levels were measured preoperatively, creatine kinase directly after surgery, and both creatine kinase and CRP on postoperative day 1 through 4. The use of pain medication and levels of pain were recorded. Creatine kinase were higher in the anterior group compared to the lateral group, reaching statistical significance directly postoperative and on day 4. Levels of CRP did not differ, reaching a maximum of mean 52 mg/L on day 3. The use of pain medication was higher in the lateral group on the day of surgery (p = 0.011), and pain levels were higher on all days in the lateral group (p < 0.007). In conclusion, the use of minimally invasive anterior approach caused less pain, but higher postoperative levels of CK, than the use of direct lateral approach.
authors: Orthopaedic Department, Sorlandet Hospital Arendal, PO Box 783, Stoa, Arendal, 4809, Norway.
authors: Knut Erik
authors: KE
authors: Mjaaland
authors: Orthopaedic Department, Oslo University Hospital, Oslo, Norway.
authors: Kjetil
authors: K
authors: Kivle
authors: Orthopaedic Department, Sorlandet Hospital Arendal, PO Box 783, Stoa, Arendal, 4809, Norway.
authors: Svein
authors: S
authors: Svenningsen
authors: Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors: Are Hugo
authors: AH
authors: Pripp
authors: Orthopaedic Department, Oslo University Hospital, Oslo, Norway.|University of Oslo, Oslo, Norway.
authors: Lars
authors: L
authors: Nordsletten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods*; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000737:chemistry; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000737:chemistry; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000503:physiopathology*; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement; D011184:Postoperative Period; D011446:Prospective Studies; D015203:Reproducibility of Results; D013514:Surgical Procedures, Operative; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D002097:C-Reactive Protein; D003402:Creatine Kinase
keywords: THA; approach; creatine kinase