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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 with a displaced femoral neck fracture

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Abstract

Summary

In this study, we found elevated levels of serum CK in the anterolateral approach to the hip compared to the direct lateral approach in patients with a displaced femoral neck fracture. No correlation was found between levels of CK and functional outcomes.

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

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Acknowledgements

The authors would like to express their gratitude and thanks to Isabel Priscilla Nunez for acquisition of data, database management, and organization of the follow-ups at the outpatient clinic. The authors would like to thank Physiotherapist Linda Hansen and Arild Ege.

Funding

The trial protocol was awarded an independent research grant of 25 000 Norwegian kroner from Smith and Nephew at the Norwegian Orthopedic meeting in 2013. The trial was funded by Helse Sør-Øst RHF and the Norwegian authorities through a PhD grant.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Sorlandet Hospital Kristiansand, Kristiansand, Norway

    T. O. Ugland, G. Haugeberg, S. H. Ugland & Ø. H. Berg

  2. University of Oslo, Oslo, Norway

    T. O. Ugland & L. Nordsletten

  3. Martina Hansen Hospital, Gjettum, Norway

    G. Haugeberg

  4. Department of Neurosciences, Rheumatology Division, INM, Norwegian University of Science and Technology, Trondheim, Norway

    G. Haugeberg

  5. Department of Orthopaedics, Sorlandet Hospital Arendal, Arendal, Norway

    S. Svenningsen

  6. Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway

    A. H. Pripp

  7. Division of Orthopaedic Surgery, Oslo University Hospital, Ullevål, Oslo, Norway

    L. Nordsletten

Authors
  1. T. O. Ugland
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  2. G. Haugeberg
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  3. S. Svenningsen
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  4. S. H. Ugland
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  5. Ø. H. Berg
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  6. A. H. Pripp
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  7. L. Nordsletten
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Corresponding author

Correspondence to T. O. Ugland.

Ethics declarations

The trial was reported based on the guidelines of the CONSORT Statement and in compliance with the Helsinki Declaration. Informed consent was obtained from all individual participants included in the study.

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Ugland, T.O., Haugeberg, G., Svenningsen, S. et al. Biomarkers of muscle damage increased in anterolateral compared to direct lateral approach to the hip in hemiarthroplasty: no correlation with clinical outcome. Osteoporos Int 29, 1853–1860 (2018). https://doi.org/10.1007/s00198-018-4557-y

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  • DOI: https://doi.org/10.1007/s00198-018-4557-y

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