Among 450 veterans of the Iraq War found unfit for continued service by an Army medical board, 29% had traumatic arthritis listed as an "unfitting condition," said Col. James Ficke, MD, of the Brooke Army Medical Center at Fort Sam Houston, Texas.
The cohort had a total of 292 injuries involving bones or joints. Half of them led to discharge because of osteoarthritis, with a mean 19.4 months (range five to 59) between the injury and the board's determination of unfitness, Ficke reported here at the American Academy of Orthopaedic Surgeons' annual meeting.
Some joint injuries nearly always led to disabling osteoarthritis. In 83 soldiers with injuries to the knees, elbows, or ankles, 80 were subsequently found to be unfit because of arthritis in those joints.
"The significance of this to the civilian community is that osteoarthritis is the fourth leading cause of disability in the world," Ficke told MedPage Today in an interview.
"For people under 40 years of age, it's a significant change in their lifestyle and their quality of life. This cohort we looked at represents those young people."
Ficke and colleagues identified the soldiers from military records as having been wounded in action before 2007 and subsequently judged to be permanently disabled.
Not surprisingly, the mechanisms of injury in this group were different from those civilians would typically encounter. Explosions accounted for 81% of the orthopedic injuries leading to arthritis.
But 64% of all the injuries were bone fractures, which civilians could sustain in car wrecks or falls. Just 11% involved shrapnel wounds to the joints and gunshots contributed another 10%.
Ficke also noted that preexisting conditions were only rarely the cause of disabling osteoarthritis, with only 8% of discharges because of arthritis related to conditions soldiers had prior to deployment.
However, preexisting back problems were somewhat more likely to worsen enough to render soldiers unfit, with 25% of back arthritis cases leading to discharge attributed to pre-deployment injuries.
The most common sites of traumatic arthritis were the knee (37 cases), shoulder (24), elbow (22), ankle (21), and spine (20).
"Posttraumatic osteoarthritis does not have a lot of answers yet, in terms of diagnosis, causes, why one individual gets it versus another [with a similar fracture] who doesn't," Ficke pointed out.
He said the study provides the foundation for research into these questions.
"I would like to know if there's a way in which we can prevent [osteoarthritis from combat injuries] so that we can mitigate the effects and get these individuals back to full function," Ficke said.
The study was funded by the U.S. Army Institute for Surgical Research.
Ficke and other authors declared they had no relevant financial interests.
- Reviewed by Dori F. Zaleznik, MD Associate Clinical Professor of Medicine, Harvard Medical School, Boston
American Academy of Orthopaedic SurgeonsSource Reference: Johnson A, et al "Impact of traumatic arthritis on a cohort of combat casualties" AAOS 2011; Abstract P185.