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Urine Desmosine as a Marker of Lung Injury Following Total Knee Arthroplasty. A Pilot Study


Lung injury following total knee arthroplasty (TKA) may occur secondary to embolization of bone debris, fat, and cement. Clinically relevant respiratory failure is rare and is therefore difficult to study. To facilitate future investigations on this subject, we evaluated the utility of the elastin breakdown product desmosine as a potential marker of lung injury during TKA surgery. The goals of this study were to answer (1) if desmosine levels would increase in response to the perioperative insults in patients undergoing TKA and (2) if this increase would differ among unilateral and bilateral TKA procedures. Twenty consecutive patients (ten unilateral and ten bilateral TKAs) were enrolled. Urine samples were collected before surgery and at 1 and 3 days postoperatively and analyzed for levels of desmosine using a validated radioimmunoassay. Baseline desmosine/creatinine ratios were higher in the unilateral as compared to the bilateral TKA group (p = 0.003). Tourniquet times, intraoperative estimated blood loss, and transfusion requirements among bilateral TKA patients were significantly higher than those of unilateral TKA recipients. Desmosine levels increased in both groups, but the rise was significant only in the bilateral group. We detected a significant increase in urine desmosine levels associated with bilateral but not unilateral TKA surgery. In the context of previous studies, our findings suggest that desmosine may be a marker of postoperative lung injury. Further research is warranted for validation and correlation of desmosine levels to clinical markers and various degrees of lung injury.

This article appears in HSS Journal: Volume 5, Number 2.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


Headshot of Stavros G. Memtsoudis, MD, PhD, MBA
Stavros G. Memtsoudis, MD, PhD, MBA
Attending Anesthesiologist, Hospital for Special Surgery
Clinical Professor of Anesthesiology, Weill Cornell Medical College
Headshot of Alejandro Gonzalez Della Valle, MD
Alejandro Gonzalez Della Valle, MD

Attending Orthopedic Surgeon, Hospital for Special Surgery
Professor, Clinical Orthopedic Surgery, Weill Cornell Medical College

Headshot of Kethy M. Jules-Elysee, MD
Kethy M. Jules-Elysee, MD
Associate Attending Anesthesiologist, Hospital for Special Surgery
Clinical Associate Professor of Anesthesiology, Weill Cornell Medical College
Headshot of Thomas P. Sculco, MD
Thomas P. Sculco, MD
Director, Complex Joint Reconstruction Center
Surgeon-in-Chief Emeritus, Hospital for Special Surgery

Barry Starcher
Department of Biochemistry, University of Texas Health Center, Tyler, TX

Yan Ma
Department of Biostatistics, Hospital for Special Surgery
Weill Cornell Medical College


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