Good Start on Using Biochemical Markers to Compare Surgical Trauma in Total Hip Replacement Approaches

Abstract

The use of minimally invasive approaches in total hip arthroplasty has been a topic of substantial controversy in the last decade. Proponents have typically pointed to more rapid recovery, reduced pain, and avoidance of excessive tissue trauma, while detractors have noted the increased technical difficulty of performing already complex procedures with reduced visibility and have noted higher rates of complications such as iatrogenic neurovascular injury, fracture, and component malposition. Many of the studies in the existing literature have been subjective, retrospective, and nonrandomized. Thus, there is a need for studies with objective measurement of clinically relevant markers. Although true blinded randomization is impractical, investigators should strive for a study design that is prospective and utilizes comparable patient groups. In their study, Bergin et al. sequentially assessed twenty-nine patients treated with a direct anterior approach by a single surgeon and compared them with twenty-eight patients treated with a standard posterior approach by two different surgeons. Levels of inflammatory markers and creatine kinase (CK), a marker of muscle injury, were assessed preoperatively, immediately postoperatively, and on postoperative days 1 and 2. The current study is valuable for several reasons. First, Bergin et al. attempted to quantify surgical trauma with a biochemical marker. Subjective measures, such …