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. 2025 May;49(5):1073-1080.
doi: 10.1007/s00264-025-06457-9. Epub 2025 Feb 20.

Fatty infiltration of periarticular muscles in patients with osteonecrosis of the femoral head

Keiji Otaka  1 , Yusuke Osawa  2 , Yasuhiko Takegami  1 , Hiroki Iida  3 , Hiroto Funahashi  1 , Shiro Imagama  1
Affiliations

Fatty infiltration of periarticular muscles in patients with osteonecrosis of the femoral head

Keiji Otaka et al. Int Orthop. 2025 May.

Abstract

Purpose: Muscle mass and fatty infiltration can be assessed on computed tomography (CT) images using the cross-sectional area (CSA) and computed tomography attenuation value (CTV). Femoral head collapse in osteonecrosis of the femoral head (ONFH) may affect both values. We investigated factors influencing the CSA and CTV of the periarticular muscles in patients with ONFH.

Methods: Overall, 101 patients with ONFH with unilateral hip pain (stage 2, 24 patients; stage 3 A, 49 patients; and stage 3B, 28 patients) were included. The CSA and mean CTV of the bilateral gluteus maximus (Gmax), gluteus medius (Gmed), gluteus minimus (Gmin), and iliopsoas (IP) muscles were measured using CT cross-sections. Bilateral comparisons and associations with Japanese Investigation Committee (JIC) stage were analysed. Multiple regression analysis was used to evaluate factors associated with the CSA and CTV.

Results: On the symptomatic side, the CSA was significantly lower for the Gmax, Gmed, and IP, whereas the CTV was significantly lower for all tested muscles (all p < 0.01). The CTV, but not the CSA, of the Gmax, Gmed, and Gmin was significantly associated with the JIC stage severity bilaterally (all p < 0.01). Multiple regression analysis showed significant associations of the CTV with age, sex, and JIC stage (all p < 0.01).

Conclusion: Symptomatic ONFH leads to decreased muscle mass and increased fatty infiltration. Femoral head collapse progression is associated with a decrease in the CTV. Periarticular muscle assessment, including on the contralateral side, is important in patients with ONFH, particularly in older women.

Keywords: Fatty infiltration; Muscle; Osteonecrosis of the femoral head.

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Conflict of interest statement

Declarations. Ethical approval: The study protocol was approved by our university’s Committee on Ethics in Human Research and the Institutional Review Board. The study procedures were conducted in accordance with the principles of the Declaration of Helsinki. Consent to participate: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Computed tomography (CT) axial image of a 43-year-old male with right ONFH Stage 3 A. The boundaries of the bilateral gluteus maximus, gluteus medius, gluteus minimus, and iliopsoas muscles were manually plotted. The cross-sectional areas (CSA) and mean CT attenuation values (CTV) were automatically calculated using analysis software
See this image and copyright information in PMC

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