Biomarkers of Inflammation Don’t Correlate with Early Outcomes of THA

    A study from Mayo Clinic – reported at the MAOA annual meeting – found no differences in pain and early functional outcomes in direct anterior THA patients vs. mini-posterior THA patients regardless of any changes in serum biomarkers for muscle damage.

    What do increased serum biomarkers of inflammation/muscle damage tell us about pain and early functional outcomes following total hip arthroplasty (THA)?

    According to a study from Mayo Clinic, not as much as orthopaedic surgeons may have been led to believe.

    The study, presented at the Mid-America Orthopaedic Association’s annual meeting, sought to “determine the correlation, if any, between serum markers of muscle damage and early functional outcomes in patients undergoing total hip arthroplasty with either a direct anterior or mini-posterior approach,” said Michael J. Taunton, MD, one of the study co-authors.

    This is significant because lower biomarkers for inflammation are often used as evidence that the direct anterior approach for THA causes less muscle damage than other surgical approaches. However, there is little literature to back this claim.

    To evaluate the role of biomarkers in detecting differences in muscle damage between the 2 approaches, Dr. Taunton and his colleagues compared 50 consecutive patients who underwent THA through the direct anterior approach with 50 consecutive patients in which the mini-posterior approach was used.

    The biomarkers of interest were:

    • Hemoglobin
    • Hematocrit
    • Myoglobin
    • Creatine kinase
    • Creatine kinase-MB
    • C-reactive protein
    • Interleukin-6
    • TNF-alpha

    Blood was collected preoperatively and on POD1 and POD2. The researchers then compared the biomarkers with operative details, complications, therapy and pain scores, and functional results from a milestone diary.

    They found no correlation between serum biomarkers and pain or early functional outcome after either surgical approach.

    Dr. Taunton noted that while he and his colleagues did see a statistically significant increase in serum creatine kinase and myoglobin in the mini-posterior patients when compared with the direct anterior patients, this “did not correlate clinically, and likely represented a threshold effect.”

    While in the hospital, the groups had similar:

    • Length of stay
    • Complications
    • Need for intravenous breakthrough analgesia
    • Ability to climb stairs
    • Maximum feet walked
    • VAS pain scores
    • Discharge disposition

    At 8 weeks, there were no statistically significant differences in:

    • Time to discontinuing gait aids or narcotics
    • Harris Hip Scores
    • Percent of patients who returned to work or driving
    • Ability to perform activities of daily living

    “Until clear values are established and a firm relationship is demonstrated, further reporting of serum biomarkers as a measure of physiological burden after orthopedic surgical procedures should be viewed as suspect,” Dr. Taunton said.

    “We saw that patients who were operated on at the same institution and underwent the same perioperative protocols, including pain control, rehab, and patient education, had equivalent early outcomes regardless of serum biomarker levels.”


    Poehling-Monaghan KL, Kamath AF, Taunton MJ, Pagnano MW, Trousdale RT, Sierra RJ. No Correlation Between Muscle Biomarkers and Early Functional Outcome after Contemporary THA (Paper 172). Presented at the Mid-America Orthopaedic Association Annual Meeting, April 22-25, 2015, Hilton Head Island, South Carolina.