Young Veteran Amputees Have Higher Hip Osteoarthritis Risk

INCHEON, South Korea — Young veterans who have lost lower limbs in combat are at particularly high risk for developing hip osteoarthritis, but even uninjured veterans of similar age and service history also have elevated risk for the disease, according to research presented at the World Congress on Osteoarthritis (OARSI) 2025 Annual Meeting.

Fraje Watson, PhD, research associate in bioengineering at Imperial College London, London, England, presented an analysis of data from the ongoing prospective longitudinal ADVANCE cohort study in UK military personnel who served in Afghanistan.

The analysis involved 1141 participants who had hip x-rays available at the study baseline, which was a mean of 8 years after injury or deployment. Around half of the participants had experienced severe enough injury during combat to require aeromedical evacuation, while the other half were a control group of military personnel who had not required aeromedical evacuation for injury and were matched for age, time and duration of deployment, and role.

Of the 577 veterans exposed to serious injury, 142 had experienced one or both lower limb amputations, 28 had experienced hip injury (with or without lower limb loss), and 407 did not experience any limb loss.

The study found that at baseline, just over 14% of veterans who had lower limb loss had hip osteoarthritis of Kellgren and Lawrence grade ≥ 2 compared with 4.4% of the control group who did not experience serious injury requiring aeromedical evacuation, representing a 3.88-fold higher likelihood of developing hip osteoarthritis. Among those who experienced serious hip injury with or without limb loss, 28.6% met the criteria for hip osteoarthritis at baseline, representing 7.18-fold higher odds of developing hip osteoarthritis than those in the control group.

At the 3-year follow-up from baseline, the study didn’t find any significantly greater increases in overall incidence of new hip osteoarthritis in the exposed groups compared with controls. But they did see significant differences in the risk for progression to more severe disease: 38.5% of the individuals who had experienced hip injury and 24.3% of those who experienced lower limb loss had progressed compared with 17% without limb loss and 14.1% of those who did not experience severe injury.

Fraje Watson, PhD“General trauma doesn’t appear to increase the risk, but hip injuries and lower limb loss do, and they also result in an increased risk of progression over time, within 8-11 years post-injury,” Watson told the conference. She suggested that the effect could be the result of altered gait biomechanics and increased contact forces on the contralateral limb, although the cohort also included individuals who had lost both limbs.

Watson also drew attention to the relatively high rate of hip osteoarthritis at baseline and follow-up even among the military veterans who had not experienced serious injury. The mean age of participants was around 34 years, and nearly two thirds were of junior rank.

“For such a young group that’s much less reported in the literature, they had quite a high baseline prevalence,” Watson told the conference. “Even if we take out the injured group and we just look at the group that served in Afghanistan but didn’t experience a significant injury, they still had a 4.4% baseline prevalence.” In comparison to this, reports suggested a prevalence of 1.4% among men younger than 40 years in the general population, she said.

Watson commented to Medscape Medical News that the higher rate of hip osteoarthritis among military personnel may reflect the physical demands of military service. “They have a really high level of activity, and the loading of their joints is potentially higher for a sustained period of time as well as being extremely active,” she said. “They might also be slightly more at higher risk of sustaining those kinds of low-level twisted ankles or meniscal injuries during training.”

An audience member asked whether the study was looking at the sacroiliac joints and low back pain in these patients, given their mechanical axis and weight-bearing might also shift with the loss of a limb.

Watson noted that a paper currently under review was examining low back pain in individuals with lower limb loss, and that there were a number of mechanical changes that happen around both the hip and lower back with limb loss.

The ADVANCE study is supported by the Headley Court Charity, LIBOR, Help for Heroes, The Nuffield Trust, the National Lottery Community Fund, the Forces in Mind Trust, Blesma, the UK Ministry of Defence, and the Office for Veterans’ Affairs. Watson had no conflicts of interest to declare.