Essential Amino Acid Supplementation Mitigates Muscle Atrophy After Total Knee Arthroplasty

Abstract

Background:Substantial muscle atrophy occurs after total knee arthroplasty (TKA), resulting in decreased strength and impaired mobility. We sought to determine whether perioperative supplementation with essential amino acids (EAA) would attenuate muscle atrophy following TKA and whether the supplements were safe for ingestion in an older surgical population.Methods:We performed a double-blind, placebo-controlled, randomized trial of 39 adults (age range, 53 to 76 years) undergoing primary unilateral TKA who ingested 20 g of EAA (n = 19) or placebo (n = 20) twice daily for 7 days preoperatively and for 6 weeks postoperatively. At baseline and 6 weeks postoperatively, magnetic resonance imaging (MRI) scans were obtained to measure quadriceps and hamstrings muscle volume. Secondary outcomes included functional mobility and strength. Data on physical activity, diet, and patient-reported outcomes (Veterans RAND 12-Item Health Survey and Knee injury and Osteoarthritis Outcome Score) were collected. Safety was determined through blood tests evaluating blood urea nitrogen, creatinine, creatinine clearance, homocysteine, and renal and liver function. Laboratory values at baseline, on the day of surgery, and at 2 days, 2 weeks, and 6 weeks postoperatively were compared between treatment groups. Analysis of covariance models, with baseline values as covariates, were used to evaluate outcomes between treatment groups. P values were adjusted for multiple tests.Results:Compared with baseline, the EAA group had significantly less decrease in mean quadriceps muscle volume compared with the placebo group in the involved leg (−8.5% ± 2.5% compared with −13.4% ± 1.9%; p = 0.033) and the contralateral leg (−1.5% ± 1.6% compared with −7.2% ± 1.4%; p = 0.014). The hamstrings also demonstrated a greater muscle-volume-sparing effect for the EAA group than for the placebo group in the involved leg (−7.4% ± 2.0% compared with −12.2% ± 1.4%; p = 0.036) and contralateral leg (−2.1% ± 1.3% compared with −7.5% ± 1.5%; p = 0.005). There were no differences between the groups in terms of functional measures or strength. Blood chemistry values varied significantly between assessments periods but did not statistically differ between groups.Conclusions:The results of the present study suggest that EAA supplementation is safe and reduces the loss of muscle volume in older adults recovering from TKA.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Effects of Timing of a Leucine-Enriched Amino Acid Supplement on Body Composition and Physical Function in Stroke Patients: A Randomized Controlled Trial

“…In the present study, whether the time of BCAA ingestion was at breakfast or post-exercise, there was no significant main effect or interaction with skeletal muscle mass. This result is in agreement with multiple previous studies [ 2 , 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Abe et al [ 25 ] reported that stroke patients had decreased skeletal muscle mass on both the affected and unaffected sides of the body starting one month after onset.…”

“…Recently, combined intervention has been viewed with keen interest; the effects of combined intervention on improving muscle strength or mass has gained a certain consensus [ 1 , 2 , 3 , 4 , 5 , 6 , 17 , 18 ], and the range of its use is expanding. Previous studies were done in patients with stroke [ 10 ], hip fracture [ 19 ], and artificial joint replacement [ 20 , 21 ].…”

Effects of Protein Supplementation Combined with Exercise Training on Muscle Mass and Function in Older Adults with Lower-Extremity Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Trials

“…We then reviewed the titles and abstracts of 83 studies to assess their eligibility, of which 26 were considered relevant to this study and thus underwent full-text assessment ( Figure 1 ). The final sample comprised six RCTs [ 31 , 32 , 61 , 62 , 63 , 64 ] published between 2013 and 2019. All of the six RCTs were included in the qualitative synthesis, and five of them were included in the meta-analysis [ 31 , 32 , 61 , 62 , 63 ].…”

Micronized sacchachitin promotes satellite cell proliferation through TAK1-JNK-AP-1 signaling pathway predominantly by TLR2 activation

“…Skeletal muscular atrophy is an unsolved issue despite of the remarkable progression of modern medication. Although novel treatments, such as photobiomodulation therapy [ 30 ], electromyostimulation [ 34 ], and amino acid supplementation [ 35 , 36 ] with or without a combination of traditional rehabilitation, have been proposed to ease the aggravation of atrophy or even to increase the muscle mass, unfortunately the effectiveness of above mentioned therapies are still limited. On the other hand, Ganoderma sp., the traditional Chinese medicinal mushrooms, which were popularly used to improve pathological conditions, such as hepatic functional impairment and cancer therapy, have recently drawn attention due to their core component, “sacchachitin” that was clinically found to be capable of improving muscular atrophy.…”