Abstract
BackgroundThe gluteus medius (GMED) affects hip function as an abductor. We evaluated muscle volume and degeneration of the GMED by using CT-based analysis and assessed factors that affect hip abductor strength in patients with unilateral hip osteoarthritis (OA).MethodsWe examined clinical and imaging findings associated with hip abductor strength in consecutive 50 patients with unilateral hip OA. Hip abductor muscle strength and Harris hip score (HHS) were assessed. Leg length discrepancy (LLD) and femoral offset were assessed using X-ray; CT assessment was employed for volumetric and qualitative GMED analysis. Volumetric analysis involved measurement of cross sectional area (CSA) and three-dimensional (3D) muscle volume. CT density was measured for the qualitative assessment of GMED degeneration with or without adjustment using a bone mineral reference phantom.ResultsHip abductor muscle strength on the affected side was significantly lower than that on the contralateral healthy side and positively correlated with overall score and score for limping of gait of HHS, demonstrating the importance of hip abductor strength for normal hip function. A significant correlation was found between CSA and 3D muscle volume, unadjusted CT density and adjusted CT density, and hip abductor strength and these CT measurements. Multiple linear regression analysis demonstrated that 3D muscle volume, adjusted CT density, and LLD are independent factors affecting hip abduction.Conclusions3D measurement of muscle volume and adjusted CT density more accurately reflect quantity and the GMED quality than do conventional assessments. Increase in muscle volume, recovery of muscle degeneration, and correction of LLD are important for improving limping in patients with hip OA.
Highlights
The gluteus medius (GMED) affects hip function as an abductor
cross-sectional area (CSA) and 3D muscle volume of the GMED on the affected side measured on Computed tomography (CT) images were significantly smaller than those on the contralateral healthy side in all patients (Table 1)
Hip abductor muscle strength had a positive correlation with overall Harris hip score (HHS) score and significantly correlated with the limping score, but not with
Summary
The gluteus medius (GMED) affects hip function as an abductor. We evaluated muscle volume and degeneration of the GMED by using CT-based analysis and assessed factors that affect hip abductor strength in patients with unilateral hip osteoarthritis (OA). Dysfunction of the GMED is responsible for unstable hip and postural imbalance of the pelvis during ambulation. A reduction in the volume of the GMED in patients with hip osteoarthritis (OA) is a major reason for Computed tomography (CT) is one of the commonly used imaging tools for the quantification of muscle volume around the hip [3, 5]. Since the GMED transverses from the pelvis to the femur and is widely variable in each patient [6], three-dimensional (3D) analysis can more precisely quantify GMED muscle volume. In addition to muscle volume, muscle quality is responsible for muscle
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