Original Contribution
Muscle Mass and Composition of the Hip, Thigh and Abdominal Muscles in Women With and Without Hip Osteoarthritis

https://doi.org/10.1016/j.ultrasmedbio.2012.04.016Get rights and content

Abstract

The objective of this study was to compare muscle mass and composition between individuals with and without hip osteoarthritis. Twenty-four women with hip osteoarthritis (OA group) and 16 healthy women (healthy group) participated in this study. Muscle thickness (MT) and echo intensity (EI) were measured as indices of muscle mass and composition, respectively, using ultrasound imaging. Seven muscles were examined: gluteus maximus, gluteus medius, quadriceps femoris, rectus abdominis, external oblique, internal oblique and transversus abdominis. MT of only quadriceps femoris in the OA group was significantly thinner than that in the healthy group. EIs of gluteus medius, quadriceps femoris and rectus abdominis were significantly higher in the OA group than those in the healthy group. Thus, actual contractile tissue of gluteus medius and rectus abdominis substantially decreased, although muscle mass was similar, whereas both quantitative and qualitative changes occurred in quadriceps femoris in patients with hip OA.

Introduction

Loss of muscle mass, also known as muscle atrophy, is caused not only by advanced age but also by muscle disuse because of certain diseases such as osteoarthritis (OA). Muscle atrophy is the primary reason for impairments in muscle strength and is related to limitations in mobility (Janssen et al. 2002). In addition to the loss of muscle mass, alterations in muscle composition, such as increased adipose tissue accumulation and water content within the muscle, is associated with poor muscle strength and functional limitations (Goodpaster et al. 2001; Sipila et al. 2004; Yamada et al. 2010; Fukumoto et al. 2012). Muscle composition can be evaluated using ultrasound imaging, whereby an enhanced echo intensity (EI) represents changes caused by increased intramuscular fibrous and adipose tissue (Heckmatt et al. 1982; Reimers et al. 1993; Pillen et al. 2009). Muscle thickness (MT) measured by ultrasound is strongly correlated with site-matched skeletal muscle mass measured using a magnetic resonance imaging (Dupont et al. 2001; Miyatani et al. 2004). Ultrasound imaging is a noninvasive, safe and easily accessible technique. Thus, MT and EI using ultrasound imaging are useful ways of estimating muscle mass and composition in a busy clinical setting. Our previous study reported that both MT and EI using ultrasound imaging were independently associated with muscle strength in healthy middle-aged and elderly subjects (Fukumoto et al. 2012).

Hip OA is a chronic joint disease that causes pain, muscle weakness and loss of physical function. Reduced muscle strength is an important determinant of functional limitation in patients with hip OA (Steultjens et al. 2001; Pua et al. 2009). While muscle strength can reduce up to 31% in patients with hip OA (Arokoski et al. 2002), no significant losses in muscle volume or cross-sectional area (CSA) of the hip and thigh muscles were found compared with those in healthy individuals (Arokoski et al. 2002; Grimaldi et al. 2009a, 2009b). However, no study has compared muscle composition between individuals with and without hip OA. Additionally, changes in abdominal muscle mass and composition in patients with hip OA are unclear. Hip OA may cause abnormal sagittal alignment and difficulty maintaining proper balance with consequent low back pain (“hip-spine syndrome”) (Offierski and MacNab 1983; Yoshimoto et al. 2005). Changes in the abdominal muscle mass and composition that provides stability to the lumbopelvic region (Hicks et al. 2005; Urquhart et al. 2005) may lead to these abnormal sagittal alignments.

Increased knowledge regarding muscle mass and composition of the hip, thigh and abdominal muscles in patients with OA compared with those in healthy adults is very important for both a physical examination and treatment to improve muscle functions in patients with hip OA. The objective of the present study was to compare muscle mass and composition of hip, thigh and abdominal muscles between individuals with hip OA and healthy adults.

Section snippets

Participants

The present study included 24 women with unilateral or bilateral hip OA (OA group) and 16 healthy women without hip OA (healthy group). The participants in the OA group were managed as outpatients at the Department of Orthopedic Surgery of Kyoto University Hospital but did not receive physical therapy. They had advanced hip OA and their disease severity was assessed by the Kellgren/Lawrence (K/L) scale (Kellgren and Lawrence 1957) as grade 3–4 (moderate to severe joint space narrowing). All the

Results

Participant characteristics are shown in Table 1. No significant differences were observed with respect to age, height, weight or body mass index between the groups. The pelvis anterior obliquity was significantly larger in the OA group compared with that in the healthy group (p < 0.05).

MT and EI are shown in Table 2. MT of the quadriceps femoris was significantly thinner (p < 0.01) with no significant difference in the MT of other muscles in the OA group compared with the healthy group. EIs of

Discussion

The OA group showed a significant decrease in MT of the quadriceps femoris but not the hip muscles, compared with that in the healthy group. Furthermore, EIs of the gluteus medius, quadriceps femoris and rectus abdominis were higher in the OA group than those in the healthy group. This is the first study to investigate and compare MT and EI of hip, thigh and abdominal muscles in individuals with and without hip OA.

Patients with hip OA exhibit muscle atrophy due to long-term disuse of lower

Acknowledgments

The authors would like to express their thanks to K. Goto (Department of Orthopedics Surgery, Nagahama City Hospital, Shiga, Japan) and Y. Yamada (Graduate School of Nursing, Kyoto Prefectural University of Medicine, Kyoto, Japan) for their helpful discussions; K. Uemura (Graduate School of Medicine, Nagoya University, Aichi, Japan) and A. Matsumura (Graduate School of Medicine, Kyoto University, Kyoto, Japan) for their practical and technical assistance; and M. Taniguchi (Department of

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