Osteoarthritis after major combat trauma: The Armed Services Trauma Rehabilitation Outcome Study

Objective To investigate the differences in clinical and radiographic knee osteoarthritis (OA) markers between injured and uninjured UK service personnel.

Methods This study was a cross-sectional analysis, 8 years post injury, of a prospective cohort study. The Knee injury and Osteoarthritis Outcome Scores (KOOS), Radiographic Kellgren and Lawrence (KL) scores, and Osteoarthritis Research Society International Scores (joint space narrowing, sclerosis, osteophytes) were obtained from 565 uninjured and 579 matched (on sex, age, rank, regiment, and role on deployment) major combat injured participants from the ADVANCE study, 35 had a knee injury and 142 had an amputation without knee injury. Kruskal-Wallis tests compared between groups for KOOS and radiographic measures. A multiple logistic regression was performed on the effects of injury on radiographic features.

Results Mean age at injury was 25.7 ± 5.2 years. Injured participants demonstrated worse KOOS values for pain (median (interquartile range): 89(72–100) vs 94(83–100)) and symptoms (80(60–90) vs 85(70–95), p < 0.001) and higher scores for radiographic variables than uninjured participants. Injured non-amputated/non-knee injured participants had worse KOOS values than uninjured participants (pain: 92(75–100) vs 94(83–100); symptoms: 80(60–90) vs 85(70–95), p < 0.01). Knee injured participants had worse KOOS values (pain: 67(55–85), symptoms: 55(35–73), p < 0.001) than all subgroups and worse radiographic measures than injured non-amputated participants. KL (≥1) and sclerosis were worse for amputees than injured non-amputated participants. Amputees had 4.04-fold increased odds (95%CI : 2.45–6.65) than uninjured participants and knee injured participants had 4.06-fold increased odds (95%CI : 1.89–8.74) of KOA (KL ≥ 1) than uninjured participants. Injured participants (without knee injury/amputation) had 1.74-fold (95%CI : 1.27–2.69) increased odds of KOA than uninjured participants.

Conclusion Major combat trauma (in addition to knee injury or amputation) has a substantial effect on the development of KOA.