This study examined whether phase angle (PhA) is associated with hip osteoarthritis (HOA) severity and quadriceps strength in patients with HOA.
A series of 549 patients with HOA, obtained from the Screening for People Suffering Sarcopenia in the Orthopedic cohort of Kobe study, were analyzed. PhA and quadriceps strength were measured using bioelectrical impedance analysis and a handheld dynamometer, respectively. The HOA severity was graded using the Kellgren-Lawrence radiographic scale. We estimated (1) mean differences in PhA by differences in HOA severity and (2) mean differences in quadriceps strength by differences in PhA using general linear models.
The patients’ mean age was 64.9 years, and 85% were women. A decreasing trend of PhA associated with increasing HOA severity was observed (P for trend < 0.001). PhA was statistically associated with a decrease in HOA grade 4 compared with that associated with HOA grade 1 (mean difference, − 0.40°; 95% confidence interval (CI), − 0.51° to − 0.30°). PhA per leg was associated with greater quadriceps strength per leg independent of age, sex, leg muscle mass, and HOA severity (mean difference per 1° increase, 3.80 Nm; 95% CI, 0.93 to 6.66). There was insufficient evidence of any difference in the association between PhA and quadriceps strength by HOA severity and sex (P for interaction = 0.07 and 0.06, respectively).
PhA gradually decreased with increasing HOA severity, especially in patients with end-stage HOA. Paying close attention to PhA might provide a key to increasing quadriceps strength, regardless of HOA severity.
• PhA gradually decreased with progression of HOA, particularly in patients with end-stage HOA.
• PhA was positively associated with quadriceps strength, regardless of HOA severity.
• PhA could be one of the indicators of quadriceps strength in patients with HOA.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Availability of data and material
The datasets generated during and/or analyzed during the present study are available from the corresponding author on reasonable request.
Inoue K, Wicart P, Kawasaki T, Huang J, Ushiyama T, Hukuda S, Courpied J (2000) Prevalence of hip osteoarthritis and acetabular dysplasia in French and Japanese adults. Rheumatology 39:745–748. https://doi.org/10.1093/rheumatology/39.7.745
Arokoski MH, Arokoski JPA, Haara M, Kankaanpää M, Vesterinen M, Niemitukia LH, Helminen HJ (2002) Hip muscle strength and muscle cross sectional area in men with and without hip osteoarthritis. J Rheumatol 29:2185–2195
Loureiro A, Constantinou M, Diamond LE, Beck B, Barrett R (2018) Individuals with mild-to-moderate hip osteoarthritis have lower limb muscle strength and volume deficits. BMC Musculoskelet Disord 19:303. https://doi.org/10.1186/s12891-018-2230-4
Rasch A, Bystrom AH, Dalen N et al (2007) Reduced muscle radiological density, cross-sectional area, and strength of major hip and knee muscles in 22 patients with hip osteoarthritis. Acta Orthop 78:505–510. https://doi.org/10.1080/17453670710014158
Rasch A, Dalén N, Berg HE (2005) Test methods to detect hip and knee muscle weakness and gait disturbance in patients with hip osteoarthritis. Arch Phys Med Rehabil 86:2371–2376. https://doi.org/10.1016/j.apmr.2005.05.019
Pua YH, Clark RA, Bryant AL (2010) Physical function in hip osteoarthritis: relationship to isometric knee extensor steadiness. Arch Phys Med Rehabil 91:1110–1116. https://doi.org/10.1016/j.apmr.2010.04.001
Pua YH, Wrigley TV, Collins M, Cowan SM, Bennell KL (2009) Self-report and physical performance measures of physical function in hip osteoarthritis: relationship to isometric quadriceps torque development. Arthritis Rheum 61:201–208. https://doi.org/10.1002/art.24277
Chen L, Nelson DR, Zhao Y, Cui Z, Johnston JA (2013) Relationship between muscle mass and muscle strength, and the impact of comorbidities: a population-based, cross-sectional study of older adults in the United States. BMC Geriatr 13:74. https://doi.org/10.1186/1471-2318-13-74
Wada O, Kurita N, Kamitani T, Nakano N, Mizuno K (2019) Influence of the severity of knee osteoarthritis on the association between leg muscle mass and quadriceps strength: the SPSS-OK study. Clin Rheumatol 38:719–725. https://doi.org/10.1007/s10067-018-4337-2
Lukaski HC, Kyle UG, Kondrup J (2017) Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis: phase angle and impedance ratio. Curr Opin Clin Nutr Metab Care 20:330–339. https://doi.org/10.1097/MCO.0000000000000387
Yamada M, Kimura Y, Ishiyama D, Nishio N, Otobe Y, Tanaka T, Ohji S, Koyama S, Sato A, Suzuki M, Ogawa H, Ichikawa T, Ito D, Arai H (2019) Phase angle is a useful indicator for muscle function in older adults. J Nutr Health Aging 23:251–255. https://doi.org/10.1007/s12603-018-1151-0
Wada O, Kurita N, Yamada M, Mizuno K (2020) Structural severity, phase angle, and quadriceps strength among patients with knee osteoarthritis: the SPSS-OK study. Clin Rheumatol. 39:3049–3056. https://doi.org/10.1007/s10067-020-05056-w
Erturk C, Altay MA, Sert C et al (2015) The body composition of patients with knee osteoarthritis: relationship with clinical parameters and radiographic severity. Aging Clin Exp Res 27:673–679. https://doi.org/10.1007/s40520-015-0325-4
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Kyle UG, Bosaeus I, De Lorenzo AD et al (2004) Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 23:1430–1453. https://doi.org/10.1016/j.clnu.2004.09.012
Kumar S, Dutt A, Hemraj S, Bhat S, Manipadybhima B (2012) Phase angle measurement in healthy human subjects through bio-impedance analysis. Iran J Basic Med Sci 15:1180–1184
Katoh M, Isozaki K (2014) Reliability of isometric knee extension muscle strength measurements of healthy elderly subjects made with a hand-held dynamometer and a belt. J Phys Ther Sci 26:1855–1859. https://doi.org/10.1589/jpts.26.1855
Ito C, Maeda R, Ishida S, Sasaki H, Harada H (2000) Correlation among fasting plasma glucose, two-hour plasma glucose levels in OGTT and HbA1c. Diabetes Res Clin Pract 50:225–230. https://doi.org/10.1016/s0168-8227(00)00187-x
Handsfield GG, Meyer CH, Hart JM, Abel MF, Blemker SS (2014) Relationships of 35 lower limb muscles to height and body mass quantified using MRI. J Biomech 47:631–638. https://doi.org/10.1016/j.jbiomech.2013.12.002
Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368:1673–1679. https://doi.org/10.1016/S0140-6736(06)69701-8
Campa F, Silva AM, Toselli S (2018) Changes in phase angle and handgrip strength induced by suspension training in older women. Int J Sports Med 39:442–449. https://doi.org/10.1055/a-0574-3166
Ribeiro AS, Schoenfeld BJ, Souza MF, Tomeleri CM, Silva AM, Teixeira DC, Sardinha LB, Cyrino ES (2017) Resistance training prescription with different load-management methods improves phase angle in older women. Eur J Sport Sci 17:913–921. https://doi.org/10.1080/17461391.2017.1310932
Mundstock E, Amaral MA, Baptista RR, Sarria EE, dos Santos RRG, Filho AD, Rodrigues CAS, Forte GC, Castro L, Padoin AV, Stein R, Perez LM, Ziegelmann PK, Mattiello R (2019) Association between phase angle from bioelectrical impedance analysis and level of physical activity: systematic review and meta-analysis. Clin Nutr 38:1504–1510. https://doi.org/10.1016/j.clnu.2018.08.031
Jingushi S, Ohfuji S, Sofue M, Hirota Y, Itoman M, Matsumoto T, Hamada Y, Shindo H, Takatori Y, Yamada H, Yasunaga Y, Ito H, Mori S, Owan I, Fujii G, Ohashi H, Iwamoto Y, Miyanishi K, Iga T, Takahira N, Sugimori T, Sugiyama H, Okano K, Karita T, Ando K, Hamaki T, Hirayama T, Iwata K, Nakasone S, Matsuura M, Mawatari T (2010) Multiinstitutional epidemiological study regarding osteoarthritis of the hip in Japan. J Orthop Sci 15:626–631. https://doi.org/10.1007/s00776-010-1507-8
Jingushi S, Ohfuji S, Sofue M et al (2011) Osteoarthritis hip joints in Japan: involvement of acetabular dysplasia. J Orthop Sci 16:156–164. https://doi.org/10.1007/s00776-011-0025-7
Weidow J, Mars J, Kärrholm J (2005) Medial and lateral osteoarthritis of the knee is related to variations of hip and pelvic anatomy. Osteoarthr Cartil 13:471–477. https://doi.org/10.1016/j.joca.2005.01.009
This study was supported by JSPS KAKENHI (Grant Number: JP15K16518). The JSPS had no role in this study except for funding.
The study was approved by the local institutional review board (No. 57, 26 January 2017) and by the Research Ethics Committee of Fukushima Medical University School of Medicine (No. 2850, 28 September 2016).
Consent to participate
Obtaining patients’ informed consent for the present study was not mandatory according to the “Ethical Guidelines for Medical and Health Research Involving Human subjects” in Japan. However, all patients provided written informed consent prior to participation.
Consent for publication
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
Cite this article
Wada, O., Yamada, M., Kamitani, T. et al. The associations of phase angle with the structural severity and quadriceps strength among patients with hip osteoarthritis: the SPSS-OK study. Clin Rheumatol 40, 1539–1546 (2021). https://doi.org/10.1007/s10067-020-05419-3
- Hip osteoarthritis
- Phase angle
- Quadriceps strength
- Structural severity