Aspartate aminotransferase (AST) is not a viable biomarker for skeletal muscle damage. An enquiry during a total hip replacement randomized study

• Published in: Human & veterinary medicine Vol. 12; no. 1; pp. 12 - 16
• Main Authors: Nistor, Dan V, Bota, Nicolae C, Caterev, Sergiu, Guseila, Alexandru, Cosma, Dan I, Todor, Adrian
• Format: Journal Article
• Language: English
• Published: Cluj-Napoca Bioflux SRL 01-03-2020
• Subjects: Aspartate aminotransferase; Biomarkers; Cement; Dehydrogenases; Dissection; Hip; Intracellular; Joint replacement surgery; Joint surgery; Laboratories; Liver; Musculoskeletal system; Myoglobins; Pathology; Patients; Prostheses; Skeletal muscle; Statistical analysis; Total hip arthroplasty; Trauma; United States > US
• ISSN: 2066-7655; 2066-7663

Introduction. Muscle damage can be caused by traumatic or metabolic injuries. In either case, damage to the muscle cells leads to expulsion of the intracellular content. This was a propellant to evaluate muscle damage caused by surgical trauma using an intracellular marker as aspartate aminotransferase (AST) during cement-less total hip arthroplasty. Objectives. The main objective of this study was to evaluate the differences in muscle damage between the muscle sparing direct anterior approach (DAA), and the trans-gluteal lateral approach (LA) by dynamically assessing levels of aspartate aminotransferase (AST) and comparing the results with a higher sensibility marker as myoglobin. Material and Method. One hundred and two (102) patients were randomized into two equal groups. Baseline values of AST where taken, but also of myoglobin for referencing. Patients underwent a total hip arthroplasty either through the DAA or LA according to the randomization protocol. AST levels where checked daily for the first 5 postoperative days, whilst myoglobin was evaluated 6 hours postoperatively. Results. There was clinically and statistically significant more muscle damage in the LA group according to myoglobin levels. There were higher levels of AST in postoperative day 2 in the LA group relative to the DAA group. AST has also significantly increased from base values in LA group in day 2 and 3 relative to the DAA group. When comparing preoperative AST levels to postoperative levels there were no clinically significant difference in any of the groups, in any days. AST did not reach in median pathological levels, regardless of time or approach. Conclusion There is less muscle damage through the DAA confirmed by myoglobin levels compared to the lateral approach when performing a total hip replacement, but AST is not sensitive enough to detect clinically significant variations.