Influence of the severity of knee osteoarthritis on the association between leg muscle mass and quadriceps strength: the SPSS-OK study

Quadriceps strength is important for maintaining functional movement in patients with knee osteoarthritis (OA). We aimed to examine whether knee OA severity weakened the magnitude of the associations between leg muscle mass, quadriceps strength, and functional movement. Screening for People Suffering Sarcopenia in Orthopedic cohort of Kobe study (SPSS-OK) was a single-center cross-sectional study. We recruited 611 patients with knee OA. Leg muscle mass was determined by bioimpedance and used as a proxy for quadriceps muscle mass. Quadriceps strength and indices of functional movement (assessed by the functional activities category of the new Knee Society Score questionnaire [KSS] and the Timed Up and Go [TUG] test) were measured. Knee OA severity was determined by the Kellgren-Lawrence radiographic grade. A series of general linear models was fitted with adjustment for confounding variables. The increase in quadriceps strength per leg associated with a 1-kg increase in leg mass per leg was 7.29 Nm, 5.43 Nm, and 3.77 Nm among patients with knee OA grade 1/2, 3, and 4, respectively (P for interaction = 0.003). A 1-Nm increase in quadriceps strength per leg was associated with both a 0.14 point increase in KSS movement score and a 0.05 s decrease in TUG, regardless of knee OA severity (P for interaction 0.430 and 0.323). Severe knee OA may reduce efficiency in the exertion of quadriceps strength by leg muscle mass even when the amount of muscle mass remains unchanged.