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Intermuscular Fat, But Not Subcutaneous Fat, Correlated With Major Complications After Primary Total Hip Arthroplasty

  • Author Footnotes
    # Jinlong Yu and Mingliang Wang contributed equally to this research.
    Jinlong Yu
    Footnotes
    # Jinlong Yu and Mingliang Wang contributed equally to this research.
    Affiliations
    Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai 200233, China
    Search for articles by this author
  • Author Footnotes
    # Jinlong Yu and Mingliang Wang contributed equally to this research.
    Mingliang Wang
    Footnotes
    # Jinlong Yu and Mingliang Wang contributed equally to this research.
    Affiliations
    Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai 200233, China
    Search for articles by this author
  • Hao Shen
    Correspondence
    Address correspondence to: H.S.
    Affiliations
    Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai 200233, China
    Search for articles by this author
  • Author Footnotes
    # Jinlong Yu and Mingliang Wang contributed equally to this research.
Published:October 15, 2022DOI:https://doi.org/10.1016/j.acra.2022.09.014

      Rationale and Objectives

      To investigate the relationship between upper-thigh intermuscular fat, subcutaneous fat measured by CT and major complications after primary total hip arthroplasty (THA).

      Materials and Methods

      Between 2015 and 2021, consecutive patients who had primary THA and preoperative hip CT were retrospectively included. Upper-thigh muscle cross-sectional intermuscular fat, subcutaneous fat, and muscle area were measured on hip CT images. The major complications included dislocation, aseptic loosening, infection, and periprosthetic fracture. The effect of upper-thigh intermuscular fat, subcutaneous fat and muscle area on the outcome was analyzed using multivariable cox proportional hazards analysis. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.

      Results

      A total of 3028 patients were included and 71 (2.34%) of them had major complications. During a median of 25 months of follow-up, patients showed increased incidence of total major complications with increased intermuscular fat area (log-rank p = 0.012). The multivariable cox regression revealed that per SD increment in intermuscular fat area was associated with higher risk of total major complications (HR = 2.04, 95% CI = 1.71–2.43, p < 0.001), dislocation (HR = 1.96, 95% CI = 1.44–2.66, p < 0.001), aseptic loosening (HR = 2.02, 95% CI = 1.30–3.16, p = 0.002), infection (HR = 1.94, 95% CI = 1.24–3.05, p = 0.004), and periprosthetic fracture (HR = 2.26, 95% CI = 1.67-3.07, p < 0.001).

      Conclusion

      Upper-thigh intermuscular fat, but not subcutaneous fat measured on CT associated with the risk of major complications after primary THA.

      Key Words

      Abbreviations:

      BMI (body mass index), CAD (coronary artery disease), CI (confidence interval), DM (diabetes mellitus), HR (hazard ratio), ICC (intraclass correlation coefficient), IMF (intermuscular fat), SCF (subcutaneous fat), SD (standard deviation), THA (total hip arthroplasty)
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      REFERENCES

        • Learmonth ID
        • Young C
        • Rorabeck C.
        The operation of the century: total hip replacement.
        Lancet. 2007; 370: 1508-1519
        • Pivec R
        • Johnson AJ
        • Mears SC
        • et al.
        Hip arthroplasty.
        Lancet. 2012; 380: 1768-1777
        • Gwam CU
        • Mistry JB
        • Mohamed NS
        • et al.
        Current epidemiology of revision total hip arthroplasty in the United States: National Inpatient Sample 2009 to 2013.
        The J arthroplasty. 2017; 32: 2088-2092
        • Hinton ZW
        • Wu CJ
        • Ryan SP
        • et al.
        Current trends in revision hip arthroplasty: indications and types of components revised.
        The J arthroplasty. 2022; 37 (e7): S611-S6S5
        • Jeschke E
        • Citak M
        • Günster C
        • et al.
        Obesity increases the risk of postoperative complications and revision rates following primary total hip arthroplasty: an analysis of 131,576 total hip arthroplasty cases.
        The J arthroplasty. 2018; 33 (e1): 2287-2292
        • Bongers J
        • Smulders K
        • Nijhof MW.
        Severe obesity increases risk of infection after revision total hip arthroplasty.
        The J arthroplasty. 2019; 34: 3023-9 e2
        • Matar HE
        • Pincus D
        • Paterson JM
        • et al.
        Early surgical complications of total hip arthroplasty in patients with morbid obesity: propensity-matched cohort study of 3683 patients.
        The J arthroplasty. 2020; 35: 2646-2651
        • Charalambous A
        • Pincus D
        • High S
        • et al.
        Association of surgical experience with risk of complication in total hip arthroplasty among patients with severe obesity.
        JAMA network open. 2021; 4e2123478
        • Rothman KJ.
        BMI-related errors in the measurement of obesity.
        Int j obesity. 2008; 32 (2005Suppl): S56-S59
        • Wang J
        • Thornton JC
        • Russell M
        • et al.
        Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements.
        The Am j clin nutrition. 1994; 60: 23-28
        • Lee JS
        • Terjimanian MN
        • Tishberg LM
        • et al.
        Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline laparotomy.
        J Am Coll Surg. 2011; 213: 236-244
        • Mehta AI
        • Babu R
        • Sharma R
        • et al.
        Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery.
        The J of bone and joint surg Am vol. 2013; 95: 323-328
        • Gupta VK
        • Zhou Y
        • Manson JF
        • et al.
        Radiographic spine adipose index: an independent risk factor for deep surgical site infection after posterior instrumented lumbar fusion.
        The spine j: off j North Am Spine Soc. 2021; 21: 1711-1717
        • Sprowls GR
        • Allen BC
        • Wilson TJ
        • et al.
        Predictive value of lateral soft tissue thickness for complications after total hip arthroplasty with a lateral incision.
        in: Proceedings. 33. Baylor University Medical Center, 2020: 336-341
        • Rey Fernández L
        • Angles Crespo F
        • Miguela Álvarez SM
        • et al.
        Soft-tissue thickness radiographic measurement: a marker to evaluate acute periprosthetic joint infection risk in total hip replacement.
        J bone and joint infection. 2021; 6: 211-217
        • Bell JA
        • Jeong A
        • Bohl DD
        • et al.
        Does peritrochanteric fat thickness increase the risk of early reoperation for infection or wound complications following total hip arthroplasty?.
        J orthopaedics. 2019; 16: 359-362
        • Mayne AIW
        • Cassidy RS
        • Magill P
        • et al.
        Increased fat depth is not associated with increased risk of surgical complications following total hip arthroplasty.
        The bone & joint j. 2020; 102-b: 1146-1150
        • Koster A
        • Murphy RA
        • Eiriksdottir G
        • et al.
        Fat distribution and mortality: the AGES-Reykjavik Study.
        Obesity (Silver Spring, Md). 2015; 23: 893-897
        • Kim YJ
        • Seo DW
        • Ko Y
        • et al.
        Subcutaneous fat area at the upper thigh level is a useful prognostic marker in the elderly with femur fracture.
        J cachexia, sarcopenia and muscle. 2021; 12: 2238-2246
        • Delmonico MJ
        • Harris TB
        • Visser M
        • et al.
        Longitudinal study of muscle strength, quality, and adipose tissue infiltration.
        The Am j clin nutr. 2009; 90: 1579-1585
        • Ko Y
        • Shin Y
        • Sung YS
        • et al.
        A reliable and robust method for the upper thigh muscle quantification on computed tomography: toward a quantitative biomarker for sarcopenia.
        BMC musculoskeletal disorders. 2022; 23: 93
        • Aggarwal VK
        • Elbuluk A
        • Dundon J
        • et al.
        Surgical approach significantly affects the complication rates associated with total hip arthroplasty.
        The bone & joint j. 2019; 101-b: 646-651
        • Chen A
        • Paxton L
        • Zheng X
        • et al.
        Association of sex with risk of 2-year revision among patients undergoing total hip arthroplasty.
        JAMA network open. 2021; 4e2110687
        • Miljkovic-Gacic I
        • Gordon CL
        • Goodpaster BH
        • et al.
        Adipose tissue infiltration in skeletal muscle: age patterns and association with diabetes among men of African ancestry.
        The Am jclin nutr. 2008; 87: 1590-1595
        • Farsijani S
        • Santanasto AJ
        • Miljkovic I
        • et al.
        The between intermuscular fat and physical performance is relationship moderated by muscle area in older adults.
        The j gerontol Series A, Biol sci med sci. 2021; 76: 115-122
        • Wang L
        • Yin L
        • Yang M
        • et al.
        Muscle density is an independent risk factor of second hip fracture: a prospective cohort study.
        J cachexia, sarcopenia and muscle. 2022; 13: 1927-1937
        • Wang L
        • Yin L
        • Zhao Y
        • et al.
        Muscle density discriminates hip fracture better than computed tomography X-ray absorptiometry hip areal bone mineral density.
        J cachexia, sarcopenia and muscle. 2020; 11: 1799-1812
        • Ingram KH
        • Hill H
        • Moellering DR
        • et al.
        Skeletal muscle lipid peroxidation and insulin resistance in humans.
        The J clin endocrinol meta. 2012; 97: E1182-E1186
        • Kietsiriroje N
        • Pearson SM
        • O'Mahoney LL
        • et al.
        Glucose variability is associated with an adverse vascular profile but only in the presence of insulin resistance in individuals with type 1 diabetes: an observational study.
        Diabetes & vascular dis res. 2022; 1914791641221103217
        • Dimova R
        • Chakarova N
        • Grozeva G
        • et al.
        The relationship between glucose variability and insulin sensitivity and oxidative stress in subjects with prediabetes.
        Diabetes res clin prac. 2019; 158107911
        • Jämsen E
        • Nevalainen P
        • Kalliovalkama J
        • et al.
        Preoperative hyperglycemia predicts infected total knee replacement.
        Eur j int med. 2010; 21: 196-201
        • Godshaw BM
        • Ojard CA
        • Adams TM
        • et al.
        Preoperative glycemic control predicts perioperative serum glucose levels in patients undergoing total joint arthroplasty.
        The J arthroplasty. 2018; 33: S76-s80
        • Jämsen E
        • Nevalainen P
        • Eskelinen A
        • et al.
        Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis.
        The J bone and joint surg Am vol. 2012; 94: e101
        • Livingston EH.
        Lower body subcutaneous fat accumulation and diabetes mellitus risk.
        Surg for obesity and related dis: offi j Am Soc for Bariatric Surg. 2006; 2: 362-368
        • Amati F
        • Pennant M
        • Azuma K
        • et al.
        Lower thigh subcutaneous and higher visceral abdominal adipose tissue content both contribute to insulin resistance.
        Obesity (Silver Spring, Md). 2012; 20: 1115-1117
        • Sprowls GR
        • Pruszynski JE
        • Allen BC.
        Distribution of fat around the Subcutaneous hip in relation to surgical approach for total hip arthroplasty.
        The J arthroplasty. 2016; 31: 1213-1217