• Yoshinori Okamoto, Hitoshi Wakama, Junya Matsuyama, Kaito Nakamura, Takafumi Saika, Shuhei Otsuki, and Masashi Neo.
• Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan. yoshinori.okamoto@ompu.ac.jp.
• Arch Orthop Trauma Surg. 2024 Apr 1; 144 (4): 176317721763-1772.

IntroductionThe 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 MethodsThis 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.ResultsA ≥ 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).ConclusionThe 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.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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