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The psoas muscle index as a useful predictor of total hip arthroplasty outcomes

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of this study is to assess the association between the psoas muscle index (PMI) and total hip arthroplasty (THA) outcomes. This is a critical issue as sarcopenia has been associated with poor patient satisfaction post-THA.

Materials and methods

This was a retrospective case–control study of 205 THAs, with a mean follow-up of 3.6 (range, 2.0–5.5) years. Age, sex, serum immune markers, spinopelvic parameters, PMI (quantified as the cross-sectional area of the psoas, bilaterally, at L3 divided by the individual’s height squared), and patient-reported outcomes were compared between patients ‘with’ (n = 118) and ‘without’ (n = 87) achievement of a minimum clinically important difference (MCID) improvement in the EuroQol 5-Dimension (EQ-5D), post-THA. Logistic regression and receiver operating characteristic curve analyses were used to identify predictive factors.

Results

A ≥ MCID improvement in the EQ-5D was associated with the PMI (odds ratio, 0.75; 95% confidence interval, 0.63–0.91; P = 0.028), prognostic nutritional index (odds ratio, 0.85; 95% confidence interval, 0.45–0.94; P = 0.043), and age (odds ratio, 1.09; 95% confidence interval, 1.01–1.18; P = 0.044). After adjusting the PMI threshold to 4.0 cm2/m2 for females and 6.4 cm2/m2 for males, there were significant differences in serum factors (P = 0.041 for albumin and P = 0.016 for a prognostic nutritional index < 40), MCID (P < 0.001 for EQ-5D, P < 0.001 for low back pain, and P = 0.008 for the Hip Disability and Osteoarthritis Outcome Score Joint Replacement score), patient satisfaction (P = 0.003), and T1 pelvic angle (P = 0.030).

Conclusion

The PMI, which is associated with nutritional status and global sagittal spinal deformity, does predict THA outcomes. Therefore, it can be useful when discussing THA expectations with patients.

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Data availability

The datasets used and/or analyzed in this study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

This study was supported by the Grants-in-Aid for Scientific Research of Japan Society KAKENHI for the Promotion of Science, Grant Number 21K09239.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan

    Yoshinori Okamoto, Hitoshi Wakama, Junya Matsuyama, Kaito Nakamura, Takafumi Saika, Shuhei Otsuki & Masashi Neo

  2. Department of Orthopedic Surgery, Saiseikai Ibaraki Hospital, 2-1-45, Mitsukeyama, Ibaraki, 567-0035, Japan

    Yoshinori Okamoto

Authors
  1. Yoshinori Okamoto
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  2. Hitoshi Wakama
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  6. Shuhei Otsuki
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  7. Masashi Neo
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Contributions

YO, HW, JM and SO designed the study. JM, KN and TS obtained the data. YO wrote the initial draft. YO and TS performed the statistical analysis. MN and YO ensured the accuracy of the data and analyses. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yoshinori Okamoto.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Consent to participate

Written, informed consent was obtained from all patients prior to study enrolment.

Consent for publication

Written, informed consent was obtained from all patients for the publication of this study.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki (1964) and its subsequent amendments and was approved by the institutional review board of Osaka Medical and Pharmaceutical University hospital (approval number- 2020-098-1).

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Okamoto, Y., Wakama, H., Matsuyama, J. et al. The psoas muscle index as a useful predictor of total hip arthroplasty outcomes. Arch Orthop Trauma Surg 144, 1763–1772 (2024). https://doi.org/10.1007/s00402-023-05146-9

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