Posttraumatic Osteoarthritis Caused by Battlefield Injuries

Rivera, Jessica C.; Wenke, Joseph C.; Buckwalter, Joseph A.; Ficke, James R.; Johnson, Anthony E.

doi:10.5435/jaaos-20-08-s64

Cited by 100 publications

(80 citation statements)

References 23 publications

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“…In the United States, PTOA accounts for approximately 12% of all symptomatic OA, affecting approximately 5.6 million patients at a cost of more than $3 billion annually 2 . The PTOA burden is dramatically increased in the military, with a prevalence more than double that of the general population, and 94.4% of the OA cases that result in an unfit for duty designation being attributable to traumatic joint injury 3 . Patients from the general population presenting with PTOA are typically 9e14 years younger than patients presenting for primary OA 2 , and patients presenting with PTOA in a military population are frequently in their late 20's and early 30's 4,5 .…”

Section: Introductionmentioning

confidence: 99%

A clinically realistic large animal model of intra-articular fracture that progresses to post-traumatic osteoarthritis

Goetz

Fredericks

Petersen

et al. 2015

Osteoarthritis and Cartilage

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Section: Introductionmentioning

confidence: 99%

A clinically realistic large animal model of intra-articular fracture that progresses to post-traumatic osteoarthritis

Goetz

Fredericks

Petersen

et al. 2015

Osteoarthritis and Cartilage

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“…A prior study on arthritis-related disability identified that a disabling arthritic condition after combat injury is the posttraumatic result of a direct joint injury 94% of the time, whereas 6% of disabling arthritis conditions are the result of conditions or injuries diagnosed before deployment [30]. As such, the arthritic conditions in our cohort may be presumed to be posttraumatic in nature, potentially establishing a similar gender difference between degenerative and posttrauma arthritis rates.…”

Section: Discussionmentioning

confidence: 82%

Disability After Deployment Injury: Are Women and Men Service Members Different?

Rivera

Hylden

Johnson

2015

Clinical Orthopaedics &Amp; Related Research

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Background Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders. Questions/purposes (1) Do women service members develop different conditions resulting in long-term disability compared with men service members after injuries sustained during deployment? (2) Do women service members have more or less severe disability after deployment injury compared with men service members? (3) Are men or women more likely to return to duty after combat injury?Methods The Department of Defense Trauma Registry was queried for women injured during deployment from 2001 to 2011. The subjects were then queried in the Physical Evaluation Board database to determine each subject's return-to-duty status and what disabling conditions and disability percentages were assigned to those who did not return to duty. Frequency of disabling conditions, disability percentages, and return-to-duty rates for 368 women were compared with a previously published cohort of 450 men service members, 378 of whom had orthopaedic injuries.Results Women who were unable to return to duty had a higher frequency of arthritic conditions (58% 378] of men, p = 0.0410; RR, 0.169; 95% CI, 0.023-1.224). Women had more severely rated posttraumatic stress disorder (PTSD) compared with men (38% ± 23% versus 19% ± 17%). Forty-eight percent (64 of 133) of battle-injured women were unable to return to active duty, resulting in a lower return-to-duty rate compared with men (34% [450 of 1333]; p = 0.003). Conclusions After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men's and women's outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability.

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“…Joint trauma in military populations has been associated with high rates of disability and medical discharge from service 38,[43][44][45][46] and likely contributes to the high rates of disability discharge associated with OA observed in this population. 37,47,48 Limited data are available on acute traumatic joint injuries in other tactical athlete populations, but they are also probably at increased risk for these injuries. Based on the available data, it is unclear how many of the OA cases in our systematic review were associated with acute traumatic joint injury; however, given the observed disparities in the incidence and prevalence of OA and the high rates of joint trauma among tactical athletes, it is likely that posttraumatic OA is contributing to these differences.…”

Section: Discussionmentioning

confidence: 99%

Osteoarthritis and the Tactical Athlete: A Systematic Review

Cameron

Driban

Svoboda

2016

Journal of Athletic Training

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Objective: Although tactical athletes (eg, military service members, law enforcement personnel, fire fighters) are exposed to several known risk factors, it remains unclear if they are at increased risk for osteoarthritis (OA). The purpose of this systematic review was to investigate the association between serving as a tactical athlete and the incidence and prevalence of OA. Data Sources: We completed a comprehensive systematic literature search in November 2014 using 12 bibliographic databases (eg, PubMed, Ovid, SportDiscus) supplemented with manual searches of reference lists. Study Selection: Studies were included if they met the following criteria: (1) an aim of the study was to investigate an association between tactical athletes and OA; (2) the outcome measure was radiographic OA, clinical OA, total joint replacement, self-reported diagnosis of OA, or placement on a waiting list for a total joint replacement; (3) the study design was a cohort study; and (4) the study was written in English. Data Extraction: One investigator extracted data from articles that met all inclusion criteria (eg, group descriptions, measures of disease burden, source of nonexposed controls). Data Synthesis: Twelve articles met the inclusion criteria and described retrospective cohort studies. Firefighters, active-duty military service members, and veteran military parachutists consistently had a higher incidence or prevalence of knee, hip, or any OA diagnosis (4 studies). Active-duty pilots and veteran military parachutists may have a higher prevalence of spine OA, but this was not statistically significant (2 studies). Occupational risk factors for OA among tactical athletes include rank and branch of military service. The risk of OA among individuals who completed mandatory national military service remains unclear (6 studies). Conclusions: The incidence of OA among tactical athletes appears to be significantly higher when compared with nonexposed controls. Further research is needed to specifically identify modifiable risk factors within this high-risk population to develop and implement effective risk-reduction strategies.

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Posttraumatic Osteoarthritis Caused by Battlefield Injuries

Cited by 100 publications

References 23 publications

A clinically realistic large animal model of intra-articular fracture that progresses to post-traumatic osteoarthritis

A clinically realistic large animal model of intra-articular fracture that progresses to post-traumatic osteoarthritis

Disability After Deployment Injury: Are Women and Men Service Members Different?

Osteoarthritis and the Tactical Athlete: A Systematic Review

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