One Week of Hospitalization Following Elective Hip Surgery Induces Substantial Muscle Atrophy in Older Patients

Objectives: Short successive periods of skeletal muscle disuse have been suggested to substantially contribute to the observed loss of skeletal muscle mass over the life span. Hospitalization of older individuals due to acute illness, injury, or major surgery generally results in a mean hospital stay of 5 to 7 days, during which the level of physical activity is strongly reduced. We hypothesized that hospitalization following elective total hip arthroplasty is accompanied by substantial leg muscle atrophy in older men and women. Design and participants: Twenty-six older patients (75 +/- 1 years) undergoing elective total hip arthroplasty participated in this observational study. Measurements: On hospital admission and on the day of discharge, computed tomographic (CT) scans were performed to assess muscle cross-sectional area (CSA) of both legs. During surgery and on the day of hospital discharge, a skeletal muscle biopsy was taken from the m. vastus lateralis of the operated leg to assess muscle fiber type-specific CSA. Results: An average of 5.6 +/- 0.3 days of hospitalization resulted in a significant decline in quadriceps (- 3.4% +/- 1.0%) and thigh muscle CSA (- 4.2% +/- 1.1%) in the nonoperated leg (P < .05). Edema resulted in a 10.3% +/- 1.7% increase in leg CSA in the operated leg (P <.05). At hospital admission, muscle fiber CSA was smaller in the type II vs type I fibers (3326 +/- 253 mu m(2) vs 4075 +/- 279 mu m(2), respectively; P < .05). During hospitalization, type I and II muscle fiber CSA tended to increase, likely due to edema in the operated leg (P = .10). Conclusions: Six days of hospitalization following elective total hip arthroplasty leads to substantial leg muscle atrophy in older patients. Effective intervention strategies are warranted to prevent the loss of muscle mass induced by short periods of muscle disuse during hospitalization. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.