Essential Amino Acid Supplementation Mitigates Muscle Atrophy After Total Knee Arthroplasty

The purpose of this study was to investigate the underlying cellular basis of muscle atrophy (Placebo) and atrophy reduction (essential amino acid supplementation, EAAs) in total knee arthroplasty (TKA) patients by examining satellite cells and other key histological markers of inflammation, recovery, and fibrosis. Forty-one subjects (53–76 yr) scheduled for TKA were randomized into two groups, ingesting 20 g of EAAs or placebo, twice-daily, for 7 days before TKA and for 6 wk after surgery. A first set of muscle biopsies was obtained from both legs before surgery in the operating room, and patients were randomly assigned and equally allocated to have two additional biopsies at either 1 or 2 wk after surgery. Biopsies were processed for gene expression and immunohistochemistry. Satellite cells were significantly higher in patients ingesting 20 g of essential amino acids twice daily for the 7 days leading up to surgery compared with Placebo (operative leg P = 0.03 for satellite cells/fiber and P = 0.05 for satellite cell proportions for Type I-associated cells and P = 0.05 for satellite cells/fiber for Type II-associated cells.) Myogenic regulatory factor gene expression was different between groups, with the Placebo Group having elevated MyoD expression at 1 wk and EAAs having elevated myogenin expression at 1 wk. M1 macrophages were more prevalent in Placebo than the EAAs Group. IL-6 and TNF-α transcripts were elevated postsurgery in both groups; however, TNF-α declined by 2 wk in the EAAs Group. EAAs starting 7 days before surgery increased satellite cells on the day of surgery and promoted a more favorable inflammatory environment postsurgery. NEW & NOTEWORTHY Clinical studies by our group indicate that the majority of muscle atrophy after total knee arthroplasty (TKA) in older adults occurs rapidly, within the first 2 wks. We have also shown that essential amino acid supplementation (EAAs) before and after TKA mitigates muscle atrophy; however, the mechanisms are unknown. These results suggest that satellite cell numbers are elevated with EAA ingestion before surgery, and after surgery, EAA ingestion positively influences markers of inflammation. Combined, these data may help inform further studies designed to address the accelerated sarcopenia that occurs in older adults after major surgery.

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Dreyer HC, Owen EC, Strycker LA, et al. Essential amino acid supplementation mitigates muscle atrophy after total knee arthroplasty: a randomized, double‐blind, placebo‐controlled trial. JBJS Open Access. 2018;(3)2:e0006. https://doi.org/10.2106/jbjs.oa.1800008128.

AORN Journal ◽

10.1002/aorn.12586 ◽

2018 ◽

Vol 109 (1) ◽

pp. 127-132

Keyword(s):

Total Knee Arthroplasty ◽

Amino Acid ◽

Open Access ◽

Knee Arthroplasty ◽

Essential Amino Acid ◽

Controlled Trial ◽

Amino Acid Supplementation ◽

Double Blind ◽

Double Blind Placebo ◽

Total Knee

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2020 Chitranjan S. Ranawat Award: Perioperative essential amino acid supplementation suppresses rectus femoris muscle atrophy and accelerates early functional recovery following total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b6.bjj-2019-1370.r1 ◽

2020 ◽

Vol 102-B (6_Supple_A) ◽

pp. 10-18 ◽

Cited By ~ 3

Author(s):

Hideki Ueyama ◽

Narihiro Kanemoto ◽

Yukihide Minoda ◽

Yoshiki Taniguchi ◽

Hiroaki Nakamura

Keyword(s):

Amino Acid ◽

Serum Albumin ◽

Muscle Atrophy ◽

Essential Amino Acid ◽

Rectus Femoris ◽

Amino Acid Supplementation ◽

Muscle Area ◽

Acid Supplementation ◽

Rectus Femoris Muscle ◽

Femoris Muscle

Aims The aim of this study was to assess the effectiveness of perioperative essential amino acid (EAA) supplementation to prevent rectus femoris muscle atrophy and facilitate early recovery of function after total knee arthroplasty (TKA). Methods The study involved 60 patients who underwent unilateral TKA for primary knee osteo-arthritis (OA). This was a double-blind, placebo-controlled, randomized control trial with patients randomly allocated to two groups, 30 patients each: the essential amino acid supplementation (9 g daily) and placebo (lactose powder, 9 g daily) groups. Supplementation and placebo were provided from one week before to two weeks after surgery. The area of the rectus femoris muscle were measured by ultrasound imaging one month before surgery and one, two, three, and four weeks postoperatively. The serum albumin level, a visual analogue knee pain score, and mobility were also measured at each time point. The time to recovery of activities of daily living (ADLs) was recorded. Postoperative nutrition and physiotherapy were identical in both groups. Results The mean relative change from baseline was as follows for the amino acid group: 116% in rectus femoris muscle area (71% to 206%); 95% in serum albumin (80% to 115%) and 39% in VAS pain (0% to 100%) at four weeks after surgery. These values in the placebo group were: 97% in muscle area (68 to 155); 89% in serum albumin (71% to 100%) and 56% in VAS pain four weeks after surgery (0% to 100%). All changes were statistically significant (p < 0.05). The mean time to recovery of ADLs was shorter in the amino acid group compared with the placebo group (p = 0.005). Conclusion Perioperative essential amino acid supplementation prevents rectus femoris muscle atrophy and accelerates early functional recovery after TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):10–18.

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Preventing Muscle Atrophy with Protein and Amino Acid Supplementation

Journal of Sports Medicine & Doping Studies ◽

10.4172/2161-0673.1000e108 ◽

2012 ◽

Vol 02 (03) ◽

Author(s):

Jennifer Bunn

Keyword(s):

Amino Acid ◽

Muscle Atrophy ◽

Amino Acid Supplementation ◽

Acid Supplementation

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Loss of Amino Acids during Hemodialysis: Effect of Oral Essential Amino Acid Supplementation

Nephron ◽

10.1159/000182233 ◽

1981 ◽

Vol 29 (1-2) ◽

pp. 25-29 ◽

Cited By ~ 9

Author(s):

T. Tepper ◽

G.K. van der Hem ◽

H.G. Klip ◽

A.J.M. Donker

Keyword(s):

Amino Acids ◽

Amino Acid ◽

Essential Amino Acid ◽

Amino Acid Supplementation ◽

Acid Supplementation

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Proteins regulating cap-dependent translation are downregulated during total knee arthroplasty

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00601.2011 ◽

2012 ◽

Vol 302 (6) ◽

pp. R702-R711 ◽

Cited By ~ 13

Author(s):

Stephen M. Ratchford ◽

Ashley N. Bailey ◽

Hilary A. Senesac ◽

Austin D. Hocker ◽

Keith Smolkowski ◽

...

Keyword(s):

Skeletal Muscle ◽

Total Knee Arthroplasty ◽

Muscle Atrophy ◽

Knee Arthroplasty ◽

Muscle Cells ◽

The United States ◽

Skeletal Muscle Cells ◽

Acute Effects ◽

Tourniquet Release ◽

Total Knee

Total knee arthroplasty (TKA) utilizes a tourniquet to reduce blood loss, maintain a clear surgical “bloodless” field, and to ensure proper bone-implant cementing. In 2007, over 600,000 TKAs were performed in the United States, and this number is projected to increase to 3.48 million procedures performed annually by 2030. The acute effects of tourniquet-induced ischemia-reperfusion (I/R) on human skeletal muscle cells are poorly understood and require critical investigation, as muscle atrophy following this surgery is rapid and represents the most significant clinical barrier to long-term normalization of physical function. To determine the acute effects of I/R on skeletal muscle cells, biopsies were obtained at baseline, maximal ischemia (prior to tourniquet release), and reperfusion (following tourniquet release). Quadriceps volume was determined before and 2 wk post-TKA by MRI. We measured a 36% decrease in phosphorylation of Akt Ser473during ischemia and 37% during reperfusion ( P < 0.05). 4E-BP1 Thr37/46phosphorylation decreased 29% during ischemia and 22% during reperfusion ( P < 0.05). eEF2 Thr56phosphorylation increased 25% during ischemia and 43% during reperfusion ( P < 0.05). Quadriceps volume decreased 12% in the TKA leg ( P < 0.05) and tended to decrease (6%) in the contralateral leg ( P = 0.1). These data suggest cap-dependent translation initiation, and elongation may be inhibited during and after TKA surgery. We propose that cap-dependent translational events occurring during surgery may precipitate postoperative changes in muscle cells that contribute to the etiology of muscle atrophy following TKA.

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