Rheumatology International

, Volume 39, Issue 4, pp 627–635 | Cite as

Fatty infiltration in the thigh muscles in knee osteoarthritis: a systematic review and meta-analysis

  • Maria Gabriela PedrosoEmail author
  • Aline Castilho de Almeida
  • Jéssica Bianca Aily
  • Marcos de Noronha
  • Stela Marcia Mattiello
Systematic review


Knee osteoarthritis is a chronic degenerative joint disease, influenced by inflammatory, mechanical and metabolic processes. Current literature shows that thigh muscles of people with knee osteoarthritis can have increased infiltration of fat, both between and within the muscles (inter- and intramuscular fat). The fatty infiltration in the thigh in this population is correlated to systemic inflammation, poor physical function, and muscle impairment and leads to metabolic impairments and muscle disfunction. The objective of this study is to systematically review the literature comparing the amount of fatty infiltration between people with knee osteoarthritis and healthy controls. A literature search on the databases MEDLINE, Embase, CINAHL SPORTDiscuss, Web of Science and Scopus from insertion to December 2018, resulted in 1035 articles, from which 7 met inclusion/exclusion criteria and were included in the review. All included studies analyzed the difference in intermuscular fat and only one study analyzed intramuscular fat. A meta-analysis (random effects model) transforming data into standardized mean difference was performed for intermuscular fat (six studies). The meta-analysis showed a standardized mean difference of 0.39 (95% confidence interval from 0.25 to 0.53), showing that people with knee osteoarthritis have more intermuscular fat than healthy controls. The single study analyzing intramuscular fat shows that people with knee osteoarthritis have more intramuscular fat fraction than healthy controls. People with knee osteoarthritis have more fatty infiltration around the thigh than people with no knee osteoarthritis. That conclusion is stronger for intermuscular fat than intramuscular fat, based on the quality and number of studies analyzed.


Arthritis Adipose tissue Fat distribution Body composition Muscle fat 



We would like to acknowledge the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) for the scholarship given to Maria Gabriela Pedroso and Aline de Castilho de Almeida.


This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) with the PhD scholarship given to Maria G. Pedroso (Process number: 2015/19232-4) and Aline C. de Almeida (Process number: 2016/05047-3).

Compliance with ethical standards

Conflict of interest

Maria G. Pedroso declares that she has no conflict of interest. Aline C. de Almeida declares that she has no conflict of interest. Jéssica B. Aily declares that she has no conflict of interest. Marcos de Noronha declares that he has no conflict of interest. Stela M. Mattiello declares that she has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

296_2019_4271_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 KB)
296_2019_4271_MOESM2_ESM.docx (17 kb)
Supplementary material 2 (DOCX 16 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Physical Therapy, Center of Biological and Health SciencesFederal University of São CarlosSão CarlosBrazil
  2. 2.Community and Allied Health Department, Rural Health SchoolLa Trobe UniversityBendigoAustralia

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