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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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Hip flexor muscle size in ballet dancers compared to athletes, and relationship to hip pain
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“Changes observed in individuals with hip OA include a reduction in gluteal muscle size reported both as cross-sectional area [10] and volume [6,11], and decreased hip muscle strength [12].”
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“…[25,31] and is often used as an outcome measure in clinical trials [12–14 , A common way to assess hip muscle strength in patients with hip OA is using an isokinetic device [21,27, 28,32], however only a few studies [2,25] have evaluated the reproducibility of such measurements in these patients.”
Skoglund, E., Lundberg, T. R., Rullman, E., Fielding, R. A., Kirn, D. R., Englund, D. A., von Berens, Å., Koochek, A., Cederholm, T., Berg, H. E., et al. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111631 · Cited by 10
Self-citationIwasa, M., Ando, W., Uemura, K., Hamada, H., Takao, M., & Sugano, N. (2022) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000002363 · Cited by 10
“Anatomic parameters reflecting the acetabular coverage may be associated with femoral head collapse [14, 27].”
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Gorski, T., Casartelli, N. C., Fitzgerald, G., Horstman, A. M. H., Masschelein, E., Essers, K. J., Maffiuletti, N. A., Sutter, R., Leunig, M., & Bock, K. D. (2024) · Skeletal Muscle · doi:10.1186/s13395-024-00364-0 · Cited by 9
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InfluentialYang, T.-J., Wen, P.-P., Ye, X., Wu, X., Zhang, C., Sun, S., Wu, Z., Zhang, G.-Y., Sun, Y.-F., Ren, Y., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0319907 · Cited by 9
“Anton’s study [33] demonstrated that a 10% increase in tissue fat decreases HU by 0.75-1, with higher fat levels in gluteal muscles indicating significant muscle wasting and reduced mobility in hip osteoarthritis patients.”
InfluentialReito, A. R., Elo, P., Nieminen, J., Puolakka, T. J. S., & Eskelinen, A. P. (2015) · Acta Orthopaedica · doi:10.3109/17453674.2015.1094713 · Cited by 9
“Comparison of patients with hip OA with healthy subjects has revealed that OA patients tend to have a higher amount of fatty atrophy and weakened muscle function in hip abductors (Rasch et al. 2007).”
BackgroundInternal calibration for opportunistic computed tomography muscle density analysis
Smith, A., Tse, J. J., Waungana, T. H., Bott, K. N., Kuczynski, M. T., Michalski, A. S., Boyd, S. K., & Manske, S. L. (2022) · PLoS ONE · doi:10.1371/journal.pone.0273203 · Cited by 9
“While our internal muscle density calibration method underestimated sucrose water phantom derived muscle density, the error was small (< 1%) compared to clinical studies that have observed 10–40% differences in muscle attenuation between healthy controls and patients with hip osteoarthritis, fractures, or aortic disea…”
BackgroundResultSabharwal, J., & Joshi, S. (2022) · Advances in Rehabilitation · doi:10.5114/areh.2022.121561 · Cited by 9
“In addition, the atrophy of the surrounding musculatures results in joint instability and excessive joint movement [9].”
Mayes, S., Matt, A.-R., Smith, P. M., & Cook, J. L. (2018) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2018.06.001 · Cited by 9
Altered erector spinae activity and trunk motion occurs with moderate and severe unilateral hip OA
Moreside, J. M., Wong, I. H.-B., & Rutherford, D. J. (2017) · Journal of Orthopaedic Research® · doi:10.1002/jor.23841 · Cited by 9
“Previous literature has shown that groups with SOA demonstrate significant weakness in the hip flexors, extensors, ab/adductors, and reduced sagittal motion of the ipsilateral hip and knee.(2,13,27,38) Greater ES activity would tend to increase lumbar stability,(39) encouraging movement to occur at the hip joint as op…”
BackgroundBerg, H. E., Truong, D., Skoglund, E., Gustafsson, T. P., & Lundberg, T. R. (2020) · Clinical Physiology and Functional Imaging · doi:10.1111/cpf.12618 · Cited by 8
“Indeed, increased fat infiltration is seen in, for example, osteoarthritic and sarcopenic individuals (Narici, Franchi, & Maganaris, 2016; Rasch et al., 2007) and is generally associated with several comorbidities (Cruz‐Jentoft, Bahat, & Bauer, 2018), highlighting the clinical relevance of this…”
BackgroundMethodInfluentialSelf-citationWada, O., Yamada, M., Kamitani, T., Mizuno, K., & Kurita, N. (2020) · Clinical Rheumatology · doi:10.1007/s10067-020-05419-3 · Cited by 8
Isshiki, K., Jinno, T., Aizawa, J., Takada, R., Sakai, T., Tachibana, T., & Okawa, A. (2021) · Progress in Rehabilitation Medicine · doi:10.2490/prm.20210052 · Cited by 7
Yoshino, K., Hagiwara, S., Nakamura, J., Horikoshi, T., Yokota, H., Shimokawa, K., Matsumoto, K., Shiko, Y., Kawasaki, Y., & Ohtori, S. (2021) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-021-04295-5 · Cited by 7
“0% [16], but no significant change for the total of the gluteus medius and minimus [6, 22].”
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Martino, A. C. D., Davico, G., Castafaro, V., Geraci, G., Stefanini, N., Tassinari, L., Viceconti, M., & Faldini, C. (2023) · International Orthopaedics · doi:10.1007/s00264-023-05762-5 · Cited by 7
“In other studies [18, 19], however, these differences were assessed using the cross-sectional area and the radiological density through CT scans.”
MethodYuri, T., Nankaku, M., Kawano, T., Murao, M., Hamada, R., Goto, K., Kuroda, Y., Kawai, T., Ikeguchi, R., & Matsuda, S. (2023) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2023.105909 · Cited by 6
Lai, M.-H., Xu, H.-C., Ding, Y., Yang, K., Xu, X., & Jiang, L. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-023-07146-7 · Cited by 6
“Rasch et al.[53] proved that the muscle weakness caused by osteoarthritis is related to decreased joint function and increased pain, and that quadriceps training can increase muscle strength and relieve joint pain.”
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“[21] report that muscular weakness around the affected joint is also a clinical feature in lower limb osteoarthritis and that hip flexion strength is reduced.”
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Exercise and Osteoarthritis: Cause and Effects
Bennell, K. L., Hinman, R. S., Wrigley, T. V., Creaby, M. W., & Hodges, P. W. (2011) · Comprehensive physiology · doi:10.1002/j.2040-4603.2011.tb00377.x · Cited by 6
Jensen, C., Roos, E. M., Kjærsgaard‐Andersen, P., & Overgaard, S. (2013) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-14-21 · Cited by 7
“First, muscle mechanic outcomes provide information about the effectiveness of the exercise intervention in terms of improving muscle strength, and both muscle weakness [45] and muscle asymmetry [46,47] have been found to be present in hip OA patients.”
BackgroundMuthusamy, S. P. B., Raju, J., Ashwin, M., Ravi, R. V., Prabhaker, M. L. C., & Subramaniam, K. (2020) · Journal of Ambient Intelligence and Humanized Computing · doi:10.1007/s12652-020-02266-7 · Cited by 6
RetractedRoach, K. E., Bird, A., Pedoia, V., Majumdar, S., & Souza, R. B. (2024) · Magnetic Resonance Imaging · doi:10.1016/j.mri.2024.04.025 · Cited by 5
Halvorson, R. T., Archibeck, E. S., Khattab, K., Ngwe, H., Ornowski, J., Akkaya, Z., Souza, R. B., O’Connell, G. D., Lotz, J. C., Diaz, C., et al. (2025) · Journal of Orthopaedic Research® · doi:10.1002/jor.26072 · Cited by 5
“The altered biomechanical function observed with hip OA has been associated with abnormal muscular activation [9 – 12] and weakness [13 – 15] and is thought to be caused by increased muscular atrophy [13, 16 – 19] and fatty infiltration, beyond what is expected for normal aging [20, 21].”
Ukai, T., Yokoyama, K., & Watanabe, M. (2024) · Nutrients · doi:10.3390/nu16030386 · Cited by 4
“Computed tomography (CT) is used to evaluate both muscle volume and muscle degeneration using Hounsfield Units (HUs) [17,20–22].”
MethodBiomechanics of Femoroacetabular Impingement
Lamontagne, M., Ng, K. C. G., Mantovani, G., & Catelli, D. S. (2014) · Springer eBooks · doi:10.1007/978-3-642-36801-1_289-1 · Cited by 5
Pelvic Inclination Angle and Hip Abductor Muscle Strength after Total Hip Arthroplasty
Kamimura, A., Sakakima, H., Miyazaki, M., Sakasegawa, M., Ijiri, K., Sunahara, N., & Matsuda, T. (2013) · Journal of Physical Therapy Science · doi:10.1589/jpts.25.215 · Cited by 5
Could the Evaluation of Muscle Strength Imbalances Be Used as a Predictor of Total Hip Arthroplasty?
Vodička, T., Bozděch, M., Gimunová, M., Svobodová, L., Zháněl, J., & Czyż, S. H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105082 · Cited by 5
“Our findings are in agreement with previous studies reporting the weakening of the extensor muscle strength in the affected extremity [17,27] without significant differences between the affected and unaffected lower extremities in the flexor muscles [27].”
ResultAssociation of physical activity with fatty infiltration of muscles after total hip arthroplasty
Kawano, T., Nankaku, M., Murao, M., Yuri, T., Kitamura, G., Goto, K., Kuroda, Y., Kawai, T., Okuzu, Y., Ikeguchi, R., et al. (2023) · Skeletal Radiology · doi:10.1007/s00256-023-04516-z · Cited by 4
“Using this technique, several studies have reported greater fatty infiltration of the hip muscles for patients with hip OA compared to their unaffected limb and to healthy controls [11, 14, 15].”
Inai, T., Edama, M., Takabayashi, T., & Kubo, M. (2017) · Journal of Ergonomics · doi:10.4172/2165-7556.1000194 · Cited by 4
“According to several previous studies, hip OA decreases both the range of motion [15] and muscle strength [5,16].”
ResultGenç, A. S., Agar, A., & Güzel, N. (2023) · Cureus · doi:10.7759/cureus.41506 · Cited by 4
“Hip osteoarthritis has been associated with a decrease in the cross-sectional area of hip muscles and an increase in fat infiltration [1,4,8].”
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Muscle and Muscle Mechanisms as Possible Factors Leading to Osteoarthritis
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Impact of osteoid osteomas of the hip on the size and fatty infiltration of the thigh muscles
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“The objective assessment of the muscle wasting may be operated by radiologists on MR images but cross-sectional areas may also be measured at CT as shown in previous works, especially those that studied the association between muscle atrophy and arthritis [32–34].”
ResultPhysical activity considerations among people with knee and hip osteoarthritis
Keysor, J. J., & Heislein, D. M. (2010) · International Journal of Clinical Rheumatology · doi:10.2217/ijr.10.63 · Cited by 4
Conservative Treatment Options for Osteoarthritis of the Hip
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“The cross-sectional area of the rectus femoris had an AUC of 0.58, a sensitivity of 0.71, and a specificity of 0.59 ( P = 0.34) surgery [11, 12, 24–26].”
InfluentialFatty infiltration of periarticular muscles in patients with osteonecrosis of the femoral head
Otaka, K., Osawa, Y., Takegami, Y., Iida, H., Funahashi, H., & Imagama, S. (2025) · International Orthopaedics · doi:10.1007/s00264-025-06457-9 · Cited by 3
“A decrease in the CTV has been reported to indicate a loss of contractile muscle [27], while CTV is more closely related to physical function than is the CSA [19, 28].”
Kitamura, G., Nankaku, M., Kawano, T., Kuriyama, S., Nakamura, S., Nishitani, K., Matsuda, S., & Ikeguchi, R. (2025) · Journal of Orthopaedic Research® · doi:10.1002/jor.70003 · Cited by 3
“A previous study has reported the muscle density of gluteus muscles and quadriceps in patients with unilateral hip OA limbs and contralateral healthy limbs [30].”
Gait Pathomechanics in Hip Disease
Foucher, K. C. (2015) · Springer eBooks · doi:10.1007/978-3-319-19905-4_5 · Cited by 3
Shinonaga, A., Matsumoto, H., Uekawa, M., Kuramoto, A., Mitani, S., & Hagino, H. (2023) · Arthroplasty Today · doi:10.1016/j.artd.2023.101118 · Cited by 3
“Previous studies have shown that pre-operative CT values of the psoas major muscle on the operative side of THA patients, including men, were 35.0 HU [11].”
InfluentialJuhlin, J., Sernert, N., & Åhlund, K. (2024) · Annals of Medicine · doi:10.1080/07853890.2024.2388701 · Cited by 3
The impact of mobilization on hip osteoarthritis
Pawłowska, K., Bochyński, R., Pawłowski, J., Jerzak, L., & Grochulska, A. (2020) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-181118 · Cited by 3
“In the synovial membrane dispersed inflammatory infiltration of lymphocyte and fibroblast develop, ligaments and the joint capsule swells resulting in effusion into the joint [6,9,10,13,14].”
The Impact of Pain on Functionality, Postural Control and Fall Risk in Woman Aged 45 to 64 Years Old
Beaupré, P., da Silva, R. A., & Chevrette, T. (2022) · Geriatrics · doi:10.3390/geriatrics7010010 · Cited by 3
Disabling hip osteoarthritis: gender, body mass, health and functional status correlates
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“The data also show considerable inter-individual differences in disease presentation and suggest more attention to classifying patients according to the presence or absence of comorbidities and mechanical or biological factors may influence the disease outcome as well as body weight, pain and functional capacity quite…”
Sato, E., Yamaji, T., & Watanabe, H. (2019) · Progress in Rehabilitation Medicine · doi:10.2490/prm.20190015 · Cited by 3
Gopalswami, A. D., Kumar, S., & Sinha, A. (2021) · Biomedicine · doi:10.51248/.v41i1.544 · Cited by 3
“In addition, the related muscles showed marked atrophy as evidenced by reduced cross sectional area as well as maximal voluntary isometric contraction (5).”
BackgroundEmery, S., Cook, J. L., Ferrar, K., & Mayes, S. (2021) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2021.06.010 · Cited by 3
Biomechanics of Femoroacetabular Impingement
Lamontagne, M., Ng, K. C. G., Mantovani, G., & Catelli, D. S. (2015) · Springer eBooks · doi:10.1007/978-3-642-36569-0_289 · Cited by 3
Karademir, F., Ayhan, Ç., Arın, G., & Soylu, A. R. (2022) · Journal of Hand Surgery (European Volume) · doi:10.1177/17531934221130669 · Cited by 4
“Pathological changes in thenar muscle morphometry can occur following trapeziometacarpal osteoarthritis (TMC OA), as OA is associated with skeletal muscle loss and muscle atrophy in various joints (Rasch et al., 2007; S K%rca and Susec-Michieli, 1980; Zacharias et al., 2016).”
BackgroundInfluentialEarly gait analysis after curved periacetabular osteotomy for acetabular dysplasia
Nishimura, M., Takahira, N., Fukushima, K., Yamamoto, T., Moriya, M., & Uchiyama, K. (2015) · Orthopedic Research and Reviews · doi:10.2147/orr.s75943 · Cited by 3
“45 Thus, the increased range of tilting movement of the trunk before surgery in our patients may have been due to compensatory movement to reduce pain and a weakened abductor muscle.”
Kii, S., Takamatsu, R., Sonohata, M., Ueno, M., Nonaka, T., Kitajima, M., & Mawatari, M. (2025) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-025-08435-z · Cited by 2
“Decreased gluteus medius volume is the main cause of limp gait in patients with hip joint osteoarthritis [30, 31].”
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InfluentialMaffiuletti, N. A., Item‐Glatthorn, J. F., Friesenbichler, B., Brioschi, M., Muendle, B., Ventura, A., Stulz, S., Leunig, M., & Casartelli, N. C. (2019) · Joint Bone Spine · doi:10.1016/j.jbspin.2019.09.013 · Cited by 2
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Exercise Prescription for Painful Hip Disorders
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“(17) tüm yönlerde azalmış kas gücü ve kas kesitsel alanında abduktorlar dışında azalma saptamışlardır.”
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“This observation also accords with recent research emphasizing the importance of muscle strength in the performance of physical tasks [8,9] and may partly explain the greater pre-surgical difficulties reported on stair climbing by the past hip fracture sub-group.”
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Immediate effects of elongation training using an elastic band on the hip abductor muscles
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“− Mesure de la densité musculaire au scanner (75,96,106)”
BackgroundArthritis and Joint Replacement
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Changes in Physical Function after Total Hip Arthroplasty for Patients with Hip Osteoarthritis
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miR-29b is Involved in Cartilage Autophagy and Muscle Atrophy in a Rat Model of Knee OsteoarthritisPreprint
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Absolut & Swedish House Mafia Present ABSOLUT GREYHOUND
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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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