Archives of physical medicine and rehabilitation · 2026
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.
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Watson Fraje C E, O'Sullivan Oliver, Bennett Alex N, Schofield Susie, Toderita Diana, Behan Fearghal P, Boos Christopher J, Fear Nicola T, Cullinan Paul, Kemp Harriet, Bull Anthony M J
Аннотация
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.
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.