Les marqueurs sériques sont-ils corrélés au caractère invasif de la procédure en arthroplastie primaire de hanche ? Étude prospective randomisée comparant les approches antérieures et latérales directes - 17/06/21

Do serum markers correlate with invasiveness of the procedure in THA? A prospective randomized study comparing direct anterior and lateral approaches

Doi : 10.1016/j.rcot.2021.04.014

Raffaele Iorio, Edoardo Viglietta ^⁎ , Daniele Mazza, Ferdinando Iannotti, Ilaria Nicolosi, Alessandro Carrozzo, Attilio Speranza, Andrea Ferretti
University of Rome “Sapienza”, Sant’Andrea Hospital, Via di Grottarossa, 1035, 00189 Rome, Italy

^⁎Auteur correspondant. University of Rome La Sapienza, Sant’Andrea Hospital, via di grottarossa, 1035/1039, Rome 00189, ItalyUniversity of Rome La Sapienza, Sant’Andrea Hospitalvia di grottarossa, 1035/1039Rome 00189Italy

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Thursday 17 June 2021
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Abstract

Background

Advantages of minimally invasive approaches for total hip arthroplasty are still matter of debate. Serum markers have been assessed as objective method to quantify muscle damage after surgery but in literature ambiguous results have been reported. The aim of this prospective randomized study was to: 1) compare serum markers elevation between a minimally invasive direct anterior approach (DAA) and a direct lateral approach (DLA), 2) to establish a correlation between serum markers increase and other peri-operative variables.

Hypothesis A lesser elevation of markers could be found in patients who underwent a minimally invasive DAA.

Patients and methods

Seventy patients were enrolled and randomly divided in two groups according to the type of the approach. All patients were treated with the same implant by the same surgeon and received the same rehabilitation protocol. Demographic data, pre-operative Harris Hip Score (HHS) and operative time were recorded. Myoglobin, creatine kinase MB (CK-MB), troponin I, C-reactive protein (CRP), haemoglobin (HB) and pain levels were measured pre- and post-operatively.

Results

Mean post-operative rise were 524.9±134.6 and 667.8±409.5 for myoglobin, 4.8±2.5 and 6.6±3.7 for CK-MB, and 16.9±5.3 and 15.4±6.4 for PCR, in DAA and DLA groups respectively. In both groups, post-operatively values were significantly higher than pre-operatively (p<0.05). Comparing the two groups, no significant differences in serum markers elevations were found. A significantly lower post-operative pain was found in DAA group than in DLA group [2,9 vs. 4,2 and 2,7 vs. 3,6 in second and third day, respectively (p<0.05)]. No significant correlation was present between the serum marker elevations and age, BMI, HHS, operative time, HB or pain levels (p>0.05).

Conclusion

Serum markers of muscle damage and inflammation increased in the post-operative period without significant differences between DAA and DLA, even though overall trend was higher in DLA group. The DAA group had significantly lower levels of post-operative pain. No significant correlation between pain and serum markers levels was found.

Level of evidence

I; randomized study.

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Keywords : THA, Approach, Minimally invasive, Direct anterior, Muscle damage

☆	Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology : Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.