Hisahiro TONOTSUKA, Hajime SUGİYAM, Daisuke TANAKA, Tatsuto ITO, Ayano AMAGAMİ, Keishi MARUMO

Postoperative creatine kinase elevation following hip arthroscopy and associated risk factors

Objective: The aim of this study was to investigate postoperative CK and risk factors for CK elevation afterhip arthroscopy.Methods: This retrospective study reviewed 122 patients (50 males, 72 females; mean age, 44.1 years)who underwent hip arthroscopy from September 2012 to March 2018. For all patients, CK was investigated preoperatively, on postoperative days 1 and 3, and at postoperative weeks 1 and 2. Univariate andmultivariate analysis was performed for parameters including sex, age, body mass index, preoperativeglomerular filtration rate, diagnosis, duration of surgery, and duration of traction to determine the riskfactors for CK > 10 upper limit of normal (CK > 10 ULN; 1900 IU/L for males and 1500 IU/L for females)after surgery.Results: Mean CK was 104.7 ± 68.7 IU/L preoperatively and 839.2 ± 2214.0, 523.9 ± 1449.4, 186.0 ± 690.7,and 122.0 ± 307.1 IU/L on postoperative days 1 and 3 and at postoperative weeks 1 and 2, respectively. CKwas significantly higher on postoperative days 1 and 3 than before surgery. In total, 11 patients (9.0%),including 8 males (16.0%) and 3 females (4.2%), had CK > 10 ULN. Younger age and longer duration oftraction are independent risk factors for CK > 10 ULN.Conclusion: After hip arthroscopy, CK levels should be monitored, especially in young patients and casesof prolonged duration of traction during surgery.

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1. Tibor LM, Leunig M. The pathoanatomy and arthroscopic management of femoroacetabular impingement. Bone Joint Res. 2012;1(10):245e257.

2. Byrd JW, Jones KS. Primary repair of the acetabular labrum: outcomes with 2 years' follow-up. Arthroscopy. 2014;30(5):588e592.

3. Yeung M, Kowalczuk M, Simunovic N, Ayeni OR. Hip arthroscopy in the setting of hip dysplasia: a systematic review. Bone Joint Res. 2016;5(6):225e231.

4. Botser IB, Smith Jr TW, Nasser R, Domb BG. Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy. 2011;27(2):270e278.

5. Domb BG, Stake CE, Botser IB, Jackson TJ. Surgical dislocation of the hip versus arthroscopic treatment of femoroacetabular impingement: a prospective matched-pair study with average 2-year follow-up. Arthroscopy. 2013;29(9): 1506e1513.

6. Sampson TG. Complications of hip arthroscopy. Clin Sports Med. 2001;20(4): 831e835.

7. Fowler J, Owens BD. Abdominal compartment syndrome after hip arthroscopy. Arthroscopy. 2010;26(1):128e130.

8. Salvo JP, Troxell CR, Duggan DP. Incidence of venous thromboembolic disease following hip arthroscopy. Orthopedics. 2010;33(9):664.

9. Papavasiliou AV, Bardakos NV. Complications of arthroscopic surgery of the hip. Bone Joint Res. 2012;1(7):131e144.

10. Youssef T, Abd-Elaal I, Zakaria G, Hasheesh M. Bariatric surgery: rhabdomyolysis after open Roux-en-Y gastric bypass: a prospective study. Int J Surg. 2010;8(6):484e488.

11. Lagandre S, Arnalsteen L, Vallet B, et al. Predictive factors for rhabdomyolysis after bariatric surgery. Obes Surg. 2006;16(10):1365e1370.

12. Tolone S, Pilone V, Musella M, et al. Rhabdomyolysis after bariatric surgery: a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South Italy. Surg Obes Relat Dis. 2016;12(2):384e390.

13. Matłok M, Major P, Małczak P, et al. Reduction of the risk of rhabdomyolysis after bariatric surgery with lower fluid administration in the perioperative period: a cohort study. Pol Arch Med Wewn. 2016;126(4):237e242.

14. Vijay MK, Vijay P, Kundu AK. Rhabdomyolysis and myogloginuric acute renal failure in the lithotomy/exaggerated lithotomy position of urogenital surgeries. Urol Ann. 2011;3(3):147e150.

15. Reisiger KE, Landman J, Kibel A, Clayman RV. Laparoscopic renal surgery and the risk of rhabdomyolysis: diagnosis and treatment. Urology. 2005;66(suppl 5):29e35.

16. De Tommasi C, Cusimano MD. Rhabdomyolysis after neurosurgery: a review and a framework for prevention. Neurosurg Rev. 2013;36(2):195e202.

17. Poli D, Gemma M, Cozzi S, Lugani D, Germagnoli L, Beretta L. Muscle enzyme elevation after elective neurosurgery. Eur J Anaesthesiol. 2007;24(6):551e555.

18. Martin HD, Palmer IJ, Champlin K, Kaiser B, Kelly B, Leunig M. Physiological changes as a result of hip arthroscopy performed with traction. Arthroscopy. 2012;28(10):1365e1372.

19. Criddle LM. Rhabdomyolysis: pathophysiology, recognition, and management. Crit Care Nurs. 2003;23(6):14e22.

20. Pasternak RC, Smith Jr SC, Bairey-Merz CN, Grundy SM, Cleeman JI, L'Enfant C. American college of cardiology; American heart association; national heart, lung and blood institute: ACC/AHA/NHLBI clinical advisory on the use and safety of statins. J Am Coll Cardiol. 2002;40(3):567e572.

21. Antons KA, Williams CD, Baker SK, Phillips PS. Clinical perspectives of statininduced rhabdomyolysis. Am J Med. 2006;119(5):400e409.

22. Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJ, de Visser M. Rhabdomyolysis: review of the literature. Neuromuscul Disord. 2014;24(8):651e659.

23. Santos-Calle FJ, Borras-Blasco J, Navarro-Ruiz A, Plaza Macias I. Unsuspected rhabdomyolysis associated with phenytoin. Int J Clin Pharmacol Ther. 2005;43(9):436e440.

24. Rosebraugh CJ, Flockhart DA, Yasuda SU, Woosley RL. Olanzapine-induced rhabdomyolysis. Ann Pharmacother. 2001;35(9):1020e1023.

25. Griffin DR, Villar RN. Complications of arthroscopy of the hip. J Bone Joint Surg Br. 1999;81(4):604e606.

26. Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61(10):1059e1064.

27. Poehling-Monaghan KL, Taunton MJ, Kamath AF, Trousdale RT, Sierra RJ, Pagnano MW. No correlation between serum markers and early functional outcome after contemporary THA. Clin Orthop Relat Res. 2017;475(2):452e462.

28. Sheth NP, Sennett B, Berns JS. Rhabdomyolysis and acute renal failure following arthroscopic knee surgery in a college football player taking creatine supplements. Clin Nephrol. 2006;65(2):134e137.

29. Lim JK, Ang KC, Wang SC, Kumar VP. Rhabdomyolysis following shoulder arthroscopy. Arthroscopy. 2006;22(12):1366.e1e1366.e5.