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. 2021 Jan 21;2(1):40-47.
doi: 10.1302/2633-1462.21.BJO-2020-0179.R1. eCollection 2021 Jan.

Gluteal atrophy and fatty infiltration in end-stage osteoarthritis of the hip: a case-control study

Kjetil Kivle  1   2 , Elisabeth S Lindland  3 , Knut Erik Mjaaland  2   4 , Svein Svenningsen  4 , Lars Nordsletten  1   2
Affiliations

Gluteal atrophy and fatty infiltration in end-stage osteoarthritis of the hip: a case-control study

Kjetil Kivle et al. Bone Jt Open. .

Abstract

Aims: The gluteus minimus (GMin) and gluteus medius (GMed) have unique structural and functional segments that may be affected to varying degrees, by end-stage osteoarthritis (OA) and normal ageing. We used data from patients with end-stage OA and matched healthy controls to 1) quantify the atrophy of the GMin and GMed in the two groups and 2) describe the distinct patterns of the fatty infiltration in the different segments of the GMin and GMed in the two groups.

Methods: A total of 39 patients with end-stage OA and 12 age- and sex frequency-matched healthy controls were prospectively enrolled in the study. Fatty infiltration within the different segments of the GMin and the GMed was assessed on MRI according to the semiquantitative classification system of Goutallier and normalized cross-sectional areas were measured.

Results: The GMin was smaller in the OA-group (p < 0.001) compared to the control group, but there was no group difference in the size of the GMed (p = 0.101). Higher levels of fatty infiltration were identified in the anterior segment of the GMin (p = 0.006) and the anterior (p = 0.006) and middle (p = 0.047) segments of the GMed in the OA group. All subjects in the control group had fatty infiltration of the anterior segment of the GMin, but all except one had no fatty infiltration in the entire GMed.

Conclusion: End-stage OA was associated with significant atrophy of the GMin and higher levels of fatty infiltration, particularly in the anterior segments of the GMin and GMed. Minor fatty infiltration of the anterior segment of GMin appears to be a normal part of ageing. Our study has demonstrated different patterns of atrophy and fatty infiltration between patients with end-stage OA and healthy matched peers.Cite this article: Bone Jt Open 2021;2(1):40-47.

Keywords: Hip; MRI; Muscle; Muscular atrophy; Osteoarthritis; Skeletal.

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Conflict of interest statement

ICMJE COI statement: The authors declare no sources of conflict of interest in relation to this work. Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

Figures

Fig. 1
Fig. 1
Transverse T1-weighted spin echo image, halfway between the tip of the greater trochanter and the anterior superior iliac spine. Cross-sectional areas of the gluteus minimus (green) and the gluteus medius (red). Other anatomical structures: * Iliacus muscle, ** Ilium, *** Piriformis muscle, **** Gluteus maximus muscle.
Fig. 2
Fig. 2
Transverse T1-weighted spin-echo image of the upper part of the gluteal muscles in a healthy control subject. The gluteus minimus (green) and gluteus medius (red) are divided in three equivalent parts: * = anterior part, **= middle part and *** = posterior part. Note the subtle fatty streaks in the anterior part of the gluteus minimus (red arrow). The gluteus medius has normal muscle without fatty infiltration.
Fig. 3
Fig. 3
Boxplot of normalized cross-sectional areas (N-CSA) of the gluteus minimus in the control and osteoarthritis (OA) group. The top and bottom of each box represent the first and third quartiles of the distribution. The horizontal line inside each box represent the median (second quartile).
Fig. 4
Fig. 4
Boxplot of normalized cross-sectional areas (N-CSA) of the gluteus medius in the control and osteoarthritis (OA) group. The top and bottom of each box represent the first and third quartiles of the distribution. The horizontal line inside each box represents the median (second quartile).
Fig. 5
Fig. 5
Bar graph of fatty infiltration of the gluteus minimus in the control and osteoarthritis (OA) group. Results of grading the fatty infiltration in the anterior, middle, and posterior part for both groups are shown. Green bars represent normal muscle (grade 0), yellow bars represent minor fatty infiltration (grade 1), and red bars represent moderate/severe fatty infiltration (grade ≥ 2).
Fig. 6
Fig. 6
Bar graph of fatty infiltration of the gluteus medius in the control and osteoarthritis (OA) group. Results of grading the fatty infiltration in the anterior, middle and posterior part for both groups are shown. Green bars represent normal muscle (grade 0), yellow bars represent minor fatty infiltration (grade 1), and red bars represent moderate/severe fatty infiltration (grade ≥2).
Fig. 7
Fig. 7
Transverse T1-weighted spin-echo image in an osteoarthritic patient of the gluteus minimus and gluteus medius. Note the moderate fatty infiltration in the anterior and middle part, and subtle fatty streaks in the posterior part of the gluteus minimus (red arrows). The gluteus medius has fatty streaks in the anterior and middle parts (yellow arrows).
See this image and copyright information in PMC

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