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 post-injury: the ADVANCE cohort.

Abstract

To compare knee osteoarthritis in people with unilateral transtibial (UTT) limb loss (LL) between (i) intact- and amputation-side knees, and (ii) ∼8-years and ∼11-years post-LL, and report knee osteoarthritis in reference population. Inception cohort SETTING: UK military PARTICIPANTS: Volunteers with UTT LL (n=36) and matched controls (n=36). N/a. Kellgren-Lawrence (KL; 0-4 [none-severe]) score and Knee injury and Osteoarthritis Outcome Score (KOOS; 100-0 [no problems-severe problems]) for Pain and Symptoms. At Baseline, ∼8-years after LL, 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=0.220). At Follow-up, KL was worse on the amputation-side compared to intact-side knee (p=0.021). 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=0.706 and p=0.138). KOOS Pain and Symptoms were not different between intact- and amputation-side knees at Baseline (Pain: median 100.0 vs. 100.0, p=0.253; Symptoms: median 90.0 vs. 86.5 p=0.573) or Follow-up (Pain: median 94.4 vs. 97.2, p=0.291; Symptoms: median 90.0 vs. 90.0 p=0.247). KOOS Pain (p=0.619 and p=0.557) and Symptoms (p=0.664 and p=0.580) were not different between Baseline and Follow-up for the intact- and amputation-side knees. For the first time, we have compared osteoarthritis of the intact- and amputation-side knee of people with UTT LL. Contrary to current opinion, radiographic osteoarthritis 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 osteoarthritis. Clinical care should focus on the intact- and amputation-side knee of people with UTT LL.