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. 2025 Apr;20(4):703-711.
doi: 10.1007/s11548-025-03321-4. Epub 2025 Jan 21.

Volume and quality of the gluteal muscles are associated with early physical function after total hip arthroplasty

Makoto Iwasa  1 , Keisuke Uemura  2 , Mazen Soufi  3 , Yoshito Otake  3 , Tomofumi Kinoshita  4 , Tatsuhiko Kutsuna  4 , Kazuma Takashima  5 , Hidetoshi Hamada  1 , Yoshinobu Sato  3 , Nobuhiko Sugano  1 , Seiji Okada  5 , Masaki Takao  4
Affiliations

Volume and quality of the gluteal muscles are associated with early physical function after total hip arthroplasty

Makoto Iwasa et al. Int J Comput Assist Radiol Surg. 2025 Apr.

Abstract

Purpose: Identifying muscles linked to postoperative physical function can guide protocols to enhance early recovery following total hip arthroplasty (THA). This study aimed to evaluate the association of preoperative pelvic and thigh muscle volume and quality with early physical function after THA in patients with unilateral hip osteoarthritis (HOA).

Methods: Preoperative Computed tomography (CT) images of 61 patients (eight males and 53 females) with HOA were analyzed. Six muscle groups were segmented from CT images, and muscle volume and quality were calculated on the healthy and affected sides. Muscle quality was quantified using the mean CT values (Hounsfield units [HU]). Early postoperative physical function was evaluated using the Timed Up & Go test (TUG) at three weeks after THA. The effect of preoperative muscle volume and quality of both sides on early postoperative physical function was assessed.

Results: On the healthy and affected sides, mean muscle mass was 9.7 cm3/kg and 8.1 cm3/kg, and mean muscle HU values were 46.0 HU and 39.1 HU, respectively. Significant differences in muscle volume and quality were observed between the affected and healthy sides. On analyzing the function of various muscle groups, the TUG score showed a significant association with the gluteus maximum volume and the gluteus medius/minimus quality on the affected side.

Conclusion: Patients with HOA showed significant muscle atrophy and fatty degeneration in the affected pelvic and thigh regions. The gluteus maximum volume and gluteus medius/minimus quality were associated with early postoperative physical function. Preoperative rehabilitation targeting the gluteal muscles on the affected side could potentially enhance recovery of physical function in the early postoperative period.

Keywords: Artificial intelligence; Deep learning; Gluteal muscles; Muscle atrophy; Postoperative recovery; Timed up and go test.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflicts of interest. Ethics approval: All procedures performed in this study were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent to participate: This study was approved by the Institutional Review Board, and written informed consent was waived because of the retrospective design.

Figures

Fig. 1
Fig. 1
Three axial slices of a computed tomography image from a patient with left hip osteoarthritis (a), along with segmented images of muscle groups and bone regions, and the reconstructed 3D model (b). Muscle group color coding: Gluteus maximus (light brown), Gluteus medius and minimus (green), Iliopsoas (dark brown), Hip adductors (light green), Quadriceps (yellow), Hamstrings (purple), Other muscles (white)
See this image and copyright information in PMC

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