Post-Traumatic Osteoarthritis, Psychological Health, and Quality of Life After Lower Limb Injury in U.S. Service Members

Shawn Farrokhi; Brittney Mazzone Gunterstockman; Brad D Hendershot; Elizabeth Russell Esposito; Cameron T McCabe; Jessica R Watrous

doi:10.1093/milmed/usad475

Post-Traumatic Osteoarthritis, Psychological Health, and Quality of Life After Lower Limb Injury in U.S. Service Members

Mil Med. 2023 Dec 18:usad475. doi: 10.1093/milmed/usad475. Online ahead of print.

Authors

Shawn Farrokhi¹, Brittney Mazzone Gunterstockman², Brad D Hendershot^{3

4

5}, Elizabeth Russell Esposito^{3

4

6}, Cameron T McCabe⁷, Jessica R Watrous⁷

Affiliations

¹ Department of Physical Therapy, Chapman University, Rinker Health Science Campus, Irvine, CA 92618, USA.
² Doctor of Physical Therapy Program, Lincoln Memorial University, Debusk College of Osteopathic Medicine, Knoxville, TN 37932, USA.
³ Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA.
⁴ Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
⁵ Department of Rehabilitation, Research and Development Section, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
⁶ Center for Limb Loss & MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA 98108, USA.
⁷ Leidos, Inc., Reston, VA 20190, USA.

PMID: 38109721
DOI: 10.1093/milmed/usad475

Abstract

Introduction: The aims of this project were to assess (1) the prevalence and timing of post-traumatic osteoarthritis (PTOA) after a traumatic lower limb injury, (2) the risk of PTOA based on injury type, and (3) the association of PTOA with psychological health and quality of life (QoL).

Materials and methods: The Wounded Warrior Recovery Project (WWRP) database and the Expeditionary Medical Encounters Dataset were queried to identify service members injured during deployment. The Military Health System Data Repository was utilized to extract medical record data to identify individuals with PTOA. Data on PTSD, depression symptoms, and QoL were extracted from the WWRP.

Results: Of the 2,061 WWRP participants with lower limb injuries, 124 (6%) were diagnosed with PTOA, with first PTOA diagnosis occurring 3.8 ± 3.1 years after injury. Of the injury categories identified, only fractures were associated with high odds of lower limb PTOA (adjusted odds ratio [OR] = 3.92, 95% confidence interval [CI]: 2.38, 6.44). Individuals with PTOA diagnoses reported lower QoL scores relative to those without PTOA (F(1,2057) = 14.21, B = -0.05, P < .05). Additionally, rates of PTSD and depression symptoms were high but not different between those with or without PTOA.

Conclusions: Despite a low prevalence of lower limb PTOA in our study, fractures increased the risk of PTOA after deployment-related injuries. Additionally, those with PTOA reported lower QoL scores relative to those without PTOA. The findings of this study highlight the personalized needs of patients with trauma beyond just the repair of the immediate injury.