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Reduced muscle radiological density, cross-sectional area, and strength of major hip and knee muscles in 22 patients with hip osteoarthritis
Open accessAbstract
BACKGROUND: Patients with hip osteoarthritis (OA) typically suffer joint pain, and often experience muscular weakness. We hypothesized that substantial atrophy would manifest in multiple muscle groups along the affected limb, resulting in severe muscle dysfunction. PATIENTS AND METHODS: We assessed 22 elderly patients with unilateral OA for maximal voluntary isometric strength of hip and knee muscles using a dynamometer that was developed for the purpose. Cross-sectional area (CSA) and radiological density (RD; in Hounsfield units: HU) of hip and knee muscles were assessed using CT. We determined SF-36, HHS, and EQ-5D. RESULTS: Hip extension, flexion, adduction, abduction, and knee extension strength were reduced (11- 29%; p < 0.01) in the OA limb relative to the healthy limb. Muscle CSA of hip extensors, flexors, adductors, knee extensors and flexors, but not hip abductors, was reduced (11-19%; p < 0.01) in the OA limb, where RD of all muscle groups except hip flexors was reduced (5-15 HU; p < 0.01). The clinical scores confirmed impairment. INTERPRETATION: Major muscles functioning around the hip and knee showed substantial loss of strength and mass, which contributes to the reduced ambulatory capacity of OA patients. Reduced muscle CSA could not fully explain the loss in strength. Infiltration with fat or other non-contractile components, as indicated by a reduced RD, in OA limb muscles was substantial.
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“The more novel measure of radiological attenuation of the quadriceps muscle, a valid proxy of contractile density [74, 75], showed no significant change in transgender women after 12 months of treatment, whereas the parallel group of transgender men demonstrated a + 6% increase in contractile density with testosterone supplementation.”
From Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage (2021) · cites this paper as [75]
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“Because of effects on psoas size and appearance [4, 6 ], we also excluded patients with significant hip osteoarthritis or prior hip arthroplasty as well as patients with prior retroperitoneal surgery.”
BackgroundHip abductor muscle volume in hip osteoarthritis and matched controls
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“There was greater muscle atrophy on the affected side in the grade 3 OA group compared to the grade 2 OA group for GMin (F(2, 37) 1⁄4 8.”
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“Reduced skeletal muscle attenuation is a typical finding in obese subjects but it is also associated with atrophy in for example rotator cuff muscles [21] and hip and knee muscles in osteoarthritis [22] where it is an independent factor apart from reduced muscular CSA, associated with reduced strength.”
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“Although previous reports have demonstrated age-related differences in composition between different muscles [16,21,27], we found the most prominent composition changes for the proximal muscles of the hip.”
InfluentialZeni, J., Pozzi, F., Abujaber, S., & Miller, L. C. (2014) · Journal of Orthopaedic Research® · doi:10.1002/jor.22772 · Cited by 89
“Although the effect of these biomechanical changes is not well understood, they may increase the demand on other lower extremity joints and place the individuals at greater risk for additional OA.”
BackgroundInfluentialAn Increased Iliocapsularis-to-rectus-femoris Ratio Is Suggestive for Instability in Borderline Hips
Haefeli, P. C., Steppacher, S. D., Babst, D., Siebenrock, K. A., & Tannast, M. (2015) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-015-4382-y · Cited by 89
“Although general atrophy of the periarticular hip muscles has been observed in end-stage osteoarthritis [7, 13, 14], isolated relative changes of muscle dimensions with hip pathologies are rarely reported in the literature [15, 21].”
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“This possibility, which has been previously suggested (Berg et al., 2007; Rasch et al., 2007), was however only partly supported by the results of the present study, where quadriceps muscle attenuation values were only slightly lower in the injured than in the healthy leg.”
ResultJensen, C., Aagaard, P., & Overgaard, S. (2011) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2011.06.011 · Cited by 76
Fukumoto, Y., Tateuchi, H., Ikezoe, T., Tsukagoshi, R., Akiyama, H., So, K., Kuroda, Y., & Ichihashi, N. (2013) · Clinical Rehabilitation · doi:10.1177/0269215513492161 · Cited by 75
“Hip osteoarthritis has been reported to cause changes in skeletal muscle properties, such as loss of muscle mass (muscle atrophy) and altered muscle composition including increased intramuscular adipose tissue(Rasch et al. 2007; Fukumoto et al. 2012a).”
Kuş, G., & Yeldan, İ. (2018) · Rheumatology International · doi:10.1007/s00296-018-4199-6 · Cited by 73
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“In contrast to other studies which selected only one plane both in the affected side and normal side [17,18], we choose three different sections.”
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“However, subjects with hip OA have a substantial loss of hip abductor muscle strength in the affected limb, compared to healthy age-matched controls [6,7].”
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“However, despite undergoing physical rehabilitation after THA, reduced muscle strength and functional performance have been reported at various time points when compared to the preoperative level [4– 12], which may already have been reduced due to end-stage osteoarthritis [4,5,8,10–15].”
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Atrophy of hip abductor muscles is related to clinical severity in a hip osteoarthritis population
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Volume Increases of the Gluteus Maximus, Gluteus Medius, and Thigh Muscles After Hip Arthroplasty
Uemura, K., Takao, M., Sakai, T., Nishii, T., & Sugano, N. (2015) · The Journal of Arthroplasty · doi:10.1016/j.arth.2015.10.036 · Cited by 56
Exercise and Osteoarthritis: Cause and Effects
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Functioning and Disability in Patients With Hip Osteoarthritis With Mild to Moderate Pain
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“Arokoski [14] Rasch [29] Subtotal (95% CI) Heterogeneity: Chi² = 0.89, df = 1 (P = 0.35); I² = 0% Test for overall effect: Z = 1.38 (P = 0.17) Test for subgroup differences: Chi² = 0.04, df = 2 (P = 0.98), I² = 0% tamination from surrounding muscles (gluteus max-imus and TFL) [9], and lack…”
InfluentialMomose, T., Inaba, Y., Choe, H., Kobayashi, N., Tezuka, T., & Saito, T. (2017) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-017-1828-2 · Cited by 46
“Upon CT assessment, several studies have measured radiological density to evaluate muscle degeneration [3, 5, 15].”
BackgroundMethodInfluentialThe Association Between Hip Muscle Cross-Sectional Area, Muscle Strength, and Bone Mineral Density
Ahedi, H. G., Aitken, D. A., Scott, D. S., Blizzard, L., Cicuttini, F., & Jones, G. (2014) · Calcified Tissue International · doi:10.1007/s00223-014-9863-6 · Cited by 45
“The relationship between muscle strength and muscle CSA has been investigated [12, 14, 15, 37] and both of these factors are affected by age [16] and disease [12, 38].”
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Muscle wasting in osteoarthritis model induced by anterior cruciate ligament transection
Silva, J. M. D. S., Alabarse, P. V. G., Teixeira, V. D. O. N., Freitas, E. C., de Oliveira, F. H., Chakr, R. M. D. S., & Xavier, R. M. (2018) · PLoS ONE · doi:10.1371/journal.pone.0196682 · Cited by 45
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“These impairments in HMS are mentioned to be the result of disuse atrophy [6,8], reflex arthrogenous inhibition of muscle contraction [9], and infiltration of noncontractile material such as fat in the muscle [10].”
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“While hip muscle atrophy is associated with hip joint pathology such as osteoarthritis (Arokoski et al., 2002; Rasch et al., 2007), previous research has found that not all muscles are affected equally and that muscle size may differ depending on the stage of pathology (Grimaldi et al.”
BackgroundMethodResultInfluentialRuple, B. A., Godwin, J. S., Mesquita, P. H. C., Osburn, S. C., Sexton, C. L., Smith, M. A., Ogletree, J. C., Goodlett, M. D., Edison, J. L., Ferrando, A. A., et al. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.728683 · Cited by 44
“Finally, the radiological density of the vastus lateralis muscle was obtained prior to and following training and compared to data yielded from the aforementioned techniques given that this metric has been suggested to largely represent myofibril protein density of muscle tissue [6,21,22].”
MethodWinther, S. B., Foss, O. A., Husby, O. S., Wik, T. S., Klaksvik, J., & Husby, V. S. (2018) · Acta Orthopaedica · doi:10.1080/17453674.2018.1441362 · Cited by 41
“■ Patients with osteoarthritis have reduced muscle strength in the affected limb preoperatively (Rasch et al. 2007), and muscle strength decreases further in the fi rst postoperative week after total hip arthroplasty (THA) (Winther et al. 2016).”
BackgroundDevelopment of a Therapeutic Exercise Program for Patients With Osteoarthritis of the Hip
Fernandes, L., Storheim, K., Nordsletten, L., & Risberg, M. A. (2010) · Physical Therapy · doi:10.2522/ptj.20090083 · Cited by 40
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Associations Between Measures of Physical Activity and Muscle Size and Strength: A Systematic Review
Rostron, Z. P. J., Green, R. A., Kingsley, M., & Zacharias, A. (2021) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2021.100124 · Cited by 38
Rahmann, A. (2010) · Open Access Journal of Sports Medicine · doi:10.2147/oajsm.s6941 · Cited by 38
“In older people with unilateral hip OA, marked differences in strength, muscle mass, activation, and force generation have been demonstrated in all the major hip and knee muscles of the arthritic limb when compared with the unaffected limb.(24,25) Similar changes have been found in people with knee OA,(26) with some a…”
Rutherford, D. J., Moreside, J. M., & Wong, I. H.-B. (2015) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2015.10.010 · Cited by 37
Current Australian physiotherapy management of hip osteoarthritis
Cowan, S., Blackburn, M., McMahon, K., & Bennell, K. L. (2010) · Physiotherapy · doi:10.1016/j.physio.2010.02.004 · Cited by 38
Goryachev, Y., Debbi, E. M., Haim, A., Rozen, N., & Alon Wolf, A. (2011) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2011.05.001 · Cited by 36
Poulsen, E., Christensen, H. W., Penny, J. Ø., Overgaard, S., Vach, W., & Hartvigsen, J. (2012) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-13-242 · Cited by 33
“Clinical practice guidelines recommend assessment of range of motion (ROM) and muscle strength when adult patients present with hip pain [4] and the two clinical signs documented to correlate with hip OA besides pain are reduced ROM [5-8] and muscle strength [5,8-11].”
BackgroundPua, Y., Wrigley, T. V., Cowan, S., & Bennell, K. L. (2009) · Arthritis Care & Research · doi:10.1002/art.24509 · Cited by 35
Muscular atrophy of the lower leg in unilateral post traumatic osteoarthritis of the ankle joint
Wiewiorski, M. J., Dopke, K., Steiger, C. N., & Valderrábano, V. (2012) · International Orthopaedics · doi:10.1007/s00264-012-1594-6 · Cited by 34
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Progressive resistance training in patients with hip dysplasia: A feasibility study
Mortensen, L., Schultz, J., Elsner, A., Jakobsen, S. S., Søballé, K., Jacobsen, J. S., Kierkegaard, S., Dalgas, U., & Mechlenburg, I. (2018) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2371 · Cited by 31
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“…lower extremity injuries, such as ankle sprains (Beckman and Buchanan, 1995; Friel et al., 2006), iliotibial band syndrome (Fredericson et al., 2000), and patellofemoral syndrome (Bolgla et al., 2011), as well as hip osteoarthritis (Rasch et al., 2007) and low back pain (Arab and Nourbakhsh, 2010).”
BackgroundHernigou, P., Roussignol, X., Delambre, J., Poignard, A., & Flouzat–Lachaniette, C.-H. (2015) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-015-4378-7 · Cited by 29
“ventionally measured by a reduced cross-sectional area [27] on CT scan.”
BackgroundMethodMinimizing Preoperative and Postoperative Limping in Patients After Total Hip Arthroplasty
Horstmann, T., Listringhaus, R., Brauner, T., Grau, S., & Mündermann, A. (2013) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e3182970fc4 · Cited by 30
“Similarly, Rasch et al.26 observed continuing improvements in hip muscle strength within 2 yrs of THA surgery in patients with unilateral hip osteoarthritis, and, in patients undergoing primary unilateral THA, hip muscle strength in all movement directions increased up to 12 wks postoperatively.27 In this study, posto…”
BackgroundInfluentialSegal, N. A., Zimmerman, M. B., Brubaker, M., & Torner, J. C. (2011) · PM&R · doi:10.1016/j.pmrj.2010.12.011 · Cited by 29
“Our finding of no difference in quadriceps CSA in subjects with and without knee OA differed from a report in which adults with knee OA had a 13%-14% decreased quadriceps CSA [63].”
BackgroundOgawa, T., Takao, M., Otake, Y., Futoshi, Y., Hamada, H., Sakai, T., Sato, Y., & Sugano, N. (2019) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2019.02.004 · Cited by 28
Steinhilber, B., Haupt, G., Miller, R., Boeer, J., Grau, S., Janßen, P., & Krauß, I. (2011) · Clinical Rheumatology · doi:10.1007/s10067-011-1893-0 · Cited by 28
“In addition to that, they have weaker hip muscles compared to healthy subjects [3, 33] as a result of disuse atrophy [3, 34] and reflex arthrogenous inhibition of muscle contraction [12, 20].”
BackgroundBurgess, L. C., Taylor, P. N., Wainwright, T. W., & Swain, I. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1939797 · Cited by 29
Standard and Advanced Imaging of Hip Osteoarthritis. What the Radiologist Should Know
Huang, B. K., Tan, W., Scherer, K., Rennie, W. J., Chung, C. B., & Bancroft, L. W. (2019) · Seminars in Musculoskeletal Radiology · doi:10.1055/s-0039-1681050 · Cited by 28
Pua, Y., Wrigley, T. V., Collins, M. L., Cowan, S., & Bennell, K. L. (2009) · Arthritis Care & Research · doi:10.1002/art.24277 · Cited by 26
Lauermann, S. P., Lienhard, K., Item‐Glatthorn, J. F., Casartelli, N. C., & Maffiuletti, N. A. (2013) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2013.10.018 · Cited by 25
“In the last few years, quadriceps muscle function has received considerable attention in patients with knee and hip osteoarthritis (OA), both before (Mizner et al., 2005b; Rasch et al., 2007) and after joint replacement surgery (Judd et al., in press; Meier et al., 2008; Mizner et al., 2005a).”
BackgroundChang, C., Lin, K., Chen, W., Jane, S., Yeh, S.-H., & Wang, T.-J. T. (2015) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000128 · Cited by 25
“The main focus of the training program was on the strength of the abductors and quadriceps, which have commonly been identified as significantly deconditioned in preoperative THR patients (Husby et al., 2009; Rasch et al., 2007).”
BackgroundZacharias, A., Pizzari, T., Semciw, A. I., English, D. J., Kapakoulakis, T., & Green, R. A. (2020) · Gait & Posture · doi:10.1016/j.gaitpost.2020.06.012 · Cited by 24
Electromyographic analysis of trunk and hip muscles during resisted lateral band walking
Youdas, J. W., Foley, B. M., Kruger, B. L., Mangus, J. M., Tortorelli, A., Madson, T. J., & Hollman, J. H. (2012) · Physiotherapy Theory and Practice · doi:10.3109/09593985.2012.704492 · Cited by 24
Estimation of spinopelvic muscles’ volumes in young asymptomatic subjects: a quantitative analysis
Amabile, C., Moal, B., Chtara, O. A., Pillet, H., Raya, J. G., Iannessi, A., Wafa Skalli, E., Lafage, V., & Bronsard, N. (2016) · Surgical and Radiologic Anatomy · doi:10.1007/s00276-016-1742-6 · Cited by 24
“Most frequently, for CT, to avoid repeated acquisitions, only a reduced set of slices is acquired, only at specific locations of interest [6, 31].”
BackgroundMethodInfluentialRane, L., & Bull, A. M. J. (2016) · Arthritis Research & Therapy · doi:10.1186/s13075-016-1155-2 · Cited by 24
“OA patients are predisposed to a number of muscular imbalances, including gluteus medius weakness [10].”
BackgroundContralateral Lower-Limb Functional Status Before Total Hip Arthroplasty
Ohmori, T., Kabata, T., Kajino, Y., Inoue, D., Kato, S., & Tsuchiya, H. (2021) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.20.00949 · Cited by 24
Kamimura, A., Sakakima, H., Tsutsumi, F., & Sunahara, N. (2014) · Rehabilitation Research and Practice · doi:10.1155/2014/861268 · Cited by 23
“Muscle atrophy occasionally occurs in patients with hip OA due to preoperative inactivity and may persist after THA; this muscle atrophy contributes to reduced ambulatory capacity and hip and knee muscle strength deficits [14, 15].”
BackgroundRelationship between foot pain, muscle strength and size: a systematic review
Latey, P. J., Burns, J., Hiller, C. E., & Nightingale, E. J. (2016) · Physiotherapy · doi:10.1016/j.physio.2016.07.006 · Cited by 22
Explosive and maximal strength before and 6 months after total hip arthroplasty
Friesenbichler, B., Casartelli, N. C., Wellauer, V., Item‐Glatthorn, J. F., Ferguson, S. J., Leunig, M., & Maffiuletti, N. A. (2017) · Journal of Orthopaedic Research® · doi:10.1002/jor.23626 · Cited by 22
“It was previously shown that the involved hip abductor muscles’ cross-sectional area was as large as in the uninvolved side in patients with hip OA, while hip flexor and extensor muscle size was reduced.(13) However, the current study showed that explosive strength was lower for hip abductors, in addition to flexors,…”
ResultGanderton, C. L., Pizzari, T., Cook, J. L., & Semciw, A. I. (2017) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2017.7229 · Cited by 22
de Lima, F., Fernandes, D. A., Melo, G., Roesler, C. R. D. M., Neves, F. D. S., & Neto, F. R. (2019) · Gait & Posture · doi:10.1016/j.gaitpost.2019.07.124 · Cited by 21
Plantar pressure distribution during standing in women with end-stage hip osteoarthritis
Miura, N., Nagai, K., Tagomori, K., Ikutomo, H., Okamura, K., Okuno, T., Nakagawa, N., & Masuhara, K. (2019) · Gait & Posture · doi:10.1016/j.gaitpost.2019.10.026 · Cited by 21
Iwasa, M., Takao, M., Soufi, M., Uemura, K., Otake, Y., Hamada, H., Sato, Y., Sugano, N., & Okada, S. (2022) · International Journal of Computer Assisted Radiology and Surgery · doi:10.1007/s11548-022-02797-8 · Cited by 20
Peiris, W. L., Cicuttini, F., Constantinou, M., Yaqobi, A., Hussain, S. M., Wluka, A. E., Urquhart, D. M., Barrett, R., Kennedy, B. A., & Wang, Y. (2020) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-020-03348-5 · Cited by 20
“Hip OA has a life time prevalence of one in four people (2) and can be both painful and disabling, severely impacting the quality of life of an individual (3).”
BackgroundHomma, D., Minato, I., Imai, N., Miyasaka, D., Sakai, Y., Horigome, Y., Suzuki, H., Dohmae, Y., & Endo, N. (2018) · Surgical and Radiologic Anatomy · doi:10.1007/s00276-018-2099-9 · Cited by 19
Damm, P., Brackertz, S., Streitparth, F., Perka, C., Bergmann, G., Duda, G. N., & Winkler, T. (2019) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2019.04.008 · Cited by 19
Kameda, M., Tanimae, H., Kihara, A., & Matsumoto, F. (2020) · Journal of Physical Therapy Science · doi:10.1589/jpts.32.173 · Cited by 19
Ohmori, T., Kabata, T., Kato, S., Takagi, T., Kajino, Y., Inoue, D., Taga, T., Yamamoto, T., Kurokawa, Y., Yoshitani, J., et al. (2020) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2020.04.011 · Cited by 19
Lohmann-Jensen, R., Holsgaard‐Larsen, A., Emmeluth, C., Overgaard, S., & Jensen, C. (2014) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-15-110 · Cited by 18
Impact of total hip arthroplasty on pain, walking ability, and cardiovascular fitness
Horstmann, T., Vornholt-Koch, S., Brauner, T., Grau, S., & Mündermann, A. (2012) · Journal of Orthopaedic Research® · doi:10.1002/jor.22163 · Cited by 17
Fukumoto, Y., Tateuchi, H., Tsukagoshi, R., Okita, Y., Akiyama, H., So, K., Kuroda, Y., & Ichihashi, N. (2016) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000000640 · Cited by 20
Gluteal muscle dysfunction and the role of specific strengthening in hip osteoarthritis: a review
French, H., Gilsenan, C., & Cusack, T. (2008) · Physical Therapy Reviews · doi:10.1179/174328808x356401 · Cited by 16
Hjorth, M. H., Stilling, M., Lorenzen, N. D., Jakobsen, S. S., Søballé, K., & Mechlenburg, I. (2014) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2014.03.007 · Cited by 16
“Hip osteoarthritis (OA) is a common degenerative condition characterised by joint pain, inter-limb asymmetry and substantial loss of muscular strength and mass (Martinez-Ramirez et al., 2013; Rasch et al., 2007).”
BackgroundMethodKoch, K., Semciw, A. I., Commean, P. K., Hillen, T. J., Fitzgerald, G. K., Clohisy, J. C. F., & Harris‐Hayes, M. (2021) · Journal of Orthopaedic Research® · doi:10.1002/jor.25158 · Cited by 16
Bieler, T., Magnusson, S. P., Christensen, H., Kjær, M., & Beyer, N. (2016) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1198426 · Cited by 17
“[34] We showed asymmetry in hip abductor strength (13%) that was almost comparable to that (15%) reported in patients awaiting hip replacement,[34] while previous reports in patients not awaiting hip replacement showed no asymmetry.”
ResultPsoas muscle atrophy following unilateral hip arthroplasty
Mak, D., Chisholm, C., Davies, A. M., Botchu, R., & James, S. (2020) · Skeletal Radiology · doi:10.1007/s00256-020-03447-3 · Cited by 15
Tsukada, A., Uchida, K., Aikawa, J., Takano, S., Iwase, D., Mukai, M., Miyagi, M., Nanri, Y., Inoue, G., & Takaso, M. (2020) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-020-02074-x · Cited by 14
Ukai, T., Ebihara, G., Omura, H., & Watanabe, M. (2021) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-021-02291-y · Cited by 14
“muscle volume around the hip [1, 2], and some studies have reported the investigation of muscle volume after”
BackgroundFunctional characteristics associated with hip abductor torque in severe hip osteoarthritis
Kawano, T., Nankaku, M., Murao, M., Goto, K., Kuroda, Y., Kawai, T., Ikeguchi, R., & Matsuda, S. (2021) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2021.102431 · Cited by 14
Metadata
- Authors
- Rasch, A., Byström, A. H., Dalen, N., & Berg, H. E.
- Affiliations
- Danderyds sjukhus (SE)
- Karolinska University Hospital (SE)
- Corresponding author
- Rasch, Anton
- ORCID
- Berg, Hans E.
- Venue
- Acta Orthopaedica
- Published
- 2007-01
- Volume
- 78
- Issue
- 4
- Pages
- 505-510
- ISSN
- 1745-3674 (ISSN-L)
- 1745-3682
- OpenAlex
- W2125543195
- Cited by
- 215
- References
- 12
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 12 · 2023: 12 · 2022: 12 · 2021: 20 · 2020: 16 · 2019: 13 · 2018: 15 · 2017: 6 · 2016: 10 · 2015: 12 · 2014: 17 · 2013: 9 · 2012: 9
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Acta Orthopaedica (publishedVersion)
- Acta Orthopaedica (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Surgery › Hip disorders and treatments
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Keywords
- hip osteoarthritis, knee osteoarthritis, muscle atrophy, muscle strength, cross-sectional area, muscle density, hip extensors, hip flexors, hip abductors, knee extensors, knee flexors, ambulatory capacity, elderly patients, fatty infiltration
- MeSH terms
- Aged, Female, Hip Joint, Humans, Isometric Contraction, Knee Joint, Male, Middle Aged, Tomography, X-Ray Computed, Osteoarthritis, Hip, Muscle, Skeletal, Muscle Weakness
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