Preoperative Quadriceps Muscle Quality Predicts Early Ambulation after Hip Fracture Surgery

Area of Science:

• Orthopedics
• Geriatric Medicine
• Radiology

Background:

• Hip fractures are a common cause of morbidity in older adults.
• Early ambulation is crucial for functional recovery and reducing complications.
• Predicting ambulation capacity preoperatively can guide patient management.

Purpose of the Study:

• To determine if preoperative muscle characteristics on CT scans predict early ambulation after hip fracture surgery.
• To compare the predictive value of muscle quality versus muscle size for ambulation.
• To identify patients at risk for limited early mobilization.

Main Methods:

• Retrospective cohort study of patients aged ≥55 years undergoing hip fracture surgery.
• Preoperative CT scans analyzed for muscle quality (Hounsfield Units) and size (CSA) of psoas, gluteal, and quadriceps muscles.
• Linear mixed-effects models used to assess associations with postoperative ambulation at POD1 and discharge, adjusted for covariates.

Main Results:

• Quadriceps muscle quality was the only significant muscle predictor of ambulation (p=0.007).
• Muscle quality outperformed muscle size in predicting early functional recovery.
• Higher BMI was associated with reduced ambulation (p=0.029); other muscle metrics and Charlson Index were not significant.

Conclusions:

• Preoperative quadriceps muscle quality is a key predictor of early postoperative ambulation after hip fracture.
• Opportunistic CT-based assessment of muscle quality can identify patients at risk for limited mobility.
• This finding supports integrating muscle quality assessment into routine preoperative evaluations.