Knee Osteoarthritis in the Intact- and Amputation-Side Knees of UK Military Personnel and Veterans With Traumatic Unilateral Transtibial Limb Loss 8 and 11 Years Postinjury: The ADVANCE Cohort

IF 4 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation Pub Date : 2026-10-01 Epub Date: 2026-03-12 DOI:10.1016/j.apmr.2026.02.497

Fraje C.E. Watson PhD, Oliver O’Sullivan PhD, Alex N. Bennett PhD, Susie Schofield MSc, Diana Toderita PhD, Fearghal P. Behan PhD, Christopher J. Boos PhD, Nicola T. Fear PhD, Paul Cullinan PhD, Harriet Kemp PhD, Anthony M.J. Bull PhD

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引用次数: 0

Abstract

Objective

To compare knee osteoarthritis (OA) in people with unilateral transtibial (UTT) limb loss (LL) between (1) intact- and amputation-side knees and (2) ∼8- and ∼11-years post-LL and to report knee OA in the reference population.

Design

Inception cohort.

Setting

UK military.

Participants

Volunteers with UTT LL (n=36) and matched controls (n=36).

Interventions

Not applicable.

Main Outcome Measures

Kellgren-Lawrence (KL; 0-4 [none–severe]) score and Knee Injury and Osteoarthritis Outcome Score (100-0 [no problems–severe problems]) for pain and symptoms.

Results

At baseline, ∼8 years after LL, the mean age was 32.9±4.2-years. Participants used dynamic–passive prosthetic limbs for daily activities and exercise. At baseline, KL was not different between intact- and amputation-side knees (P=.220). At follow-up, KL was worse on the amputation side than intact-side knee (P=.021). Rank-biserial correlation indicated that, for a randomly chosen pair, the amputation-side knee was 67% more likely to have a higher KL score than the intact-side knee. On both the intact- and amputation-side knees, KL was not different between baseline and follow-up (P=.706 and .138). Knee Injury and Osteoarthritis Outcome Score pain and symptoms were not different between intact- and amputation-side knees at baseline (pain: median, 100.0 vs 100.0; P=.253; symptoms: median, 90.0 vs 86.5; P=.573) or follow-up (pain: median, 94.4 vs 97.2; P=.291; symptoms: median, 90.0 vs 90.0; P=.247). Knee Injury and Osteoarthritis Outcome Score Pain (P=.619 and .557) and Symptoms (P=.664 and .580) were not different between baseline and follow-up for the intact- and amputation-side knees.

Conclusions

For the first time, we have compared OA of the intact- and amputation-side knee of people with UTT LL. Contrary to current opinion, radiographic OA was worse on the amputation-side knee 11 years post-LL. Modern military populations may be unique in their access to rehabilitation and prosthetic technology, resulting in different patterns of OA. Clinical care should focus on the intact- and amputation-side knee of people with UTT LL.

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ADVANCE队列研究：损伤后8年和11年创伤性单侧经胫骨肢体丧失的英国军人和退伍军人的完整和截肢侧膝关节骨性关节炎。

目的：比较单侧经胫（UTT）肢体丧失（LL）患者的膝关节骨性关节炎，包括(i)完整和截肢侧膝关节，以及（ii） LL后8年和11年，并在参考人群中报道膝关节骨性关节炎。设计：初始队列设置：英国军队参与者：UTT LL志愿者（n=36）和匹配对照（n=36）。干预措施:N / a。主要结局指标：疼痛和症状的Kellgren-Lawrence评分（KL； 0-4[无严重]）和膝关节损伤和骨关节炎结局评分（KOOS； 100-0[无问题-严重问题]）。结果：在基线时，LL后8年，平均年龄为32.9±4.2岁。参与者使用动态被动假肢进行日常活动和锻炼。基线时，完整侧和截肢侧膝关节间KL无差异（p=0.220）。在随访中，与完整侧膝关节相比，截肢侧的KL更严重（p=0.021）。秩双列相关表明，对于随机选择的一对患者，截肢侧膝关节的KL评分比完整侧膝关节高67%。在完整侧和截肢侧膝关节上，KL在基线和随访期间没有差异（p=0.706和p=0.138）。基线（疼痛：中位数100.0 vs 100.0, p=0.253；症状：中位数90.0 vs 86.5 p=0.573）或随访（疼痛：中位数94.4 vs 97.2, p=0.291；症状：中位数90.0 vs 90.0 p=0.247）时，完整侧和截肢侧膝关节的疼痛和症状无差异。完整侧和截肢侧膝关节的疼痛（p=0.619和p=0.557）和症状（p=0.664和p=0.580）在基线和随访期间无差异。结论：我们首次比较了UTT - LL患者完整侧膝关节和截肢侧膝关节的骨关节炎。与目前的观点相反，截肢侧膝关节的x线骨关节炎在ll后11年更严重。现代军人在获得康复和假肢技术方面可能是独一无二的，这导致了不同类型的骨关节炎。临床护理应侧重于UTT - LL患者的完整和截肢侧膝关节。

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来源期刊

Archives of physical medicine and rehabilitation 医学-康复医学

CiteScore

6.20

自引率

4.70%

发文量

495

审稿时长

38 days

期刊介绍： The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.