Muscle Quality Matters More Than Quantity in Hip Fracture Recovery

Abstract

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To the Editor,

Unno et al. [1] recently highlighted the importance of preoperative intramuscular adipose tissue content (IMAC) in early functional recovery after hip fracture.

In daily rehabilitation practice, we frequently encounter patients who demonstrate preserved systemic stability—adequate nutritional indices and stable vital parameters—yet remain unable to initiate effective gait despite intensive therapy. The findings by Unno et al. provide a compelling physiological explanation for this clinical discrepancy: a dissociation between “systemic metabolic reserve” (reflected by PhA) [2] and “locomotor mechanical integrity” (reflected by IMAC) [1].

The authors' observation that IMAC independently predicts walking recovery, while PhA does not, raises a critical question regarding our current therapeutic strategies: Are conventional resistance‐based rehabilitation paradigms sufficient for patients with high IMAC? [3] The presence of myosteatosis implies a qualitative deficit in motor unit recruitment and force transmission. Consequently, we propose that patients identified with high preoperative IMAC might require distinct interventions, such as targeted neuromuscular re‐education or high‐velocity power training, rather than standard strengthening protocols alone.

Finally, while the authors acknowledge the 2‐week follow‐up limitation, this early period is often just the beginning of the functional journey. In models like Taiwan's nationwide Post‐Acute Care (PAC) program, patients undergo high‐intensity rehabilitation for several weeks to months [4]. Whether IMAC retains its strong predictive value for ambulatory recovery during such prolonged, high‐intensity rehabilitation remains an important and clinically actionable question that warrants further investigation.

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Conflicts of Interest

The authors declare no conflicts of interest.