Key Challenges to the Future

 
V.F.4
 

Lead Author(s): 

Lt Michelle M Gosselin, MD, Primary
Lt Col Christopher T. LeBrun, MD

Supporting Author(s): 

Sylvia I Watkins-Castillo, PhD

The impact of musculoskeletal injuries on the service member does not stop when they leave the military. Degenerative conditions have been shown to plague the aging military population. Fragility fractures are less common in the active duty population, but certainly have a profound effect on the Veteran community. The years of consistent physical demands placed on the bodies of Active Duty service members results in life-long musculoskeletal issues, particularly post-traumatic arthritis, as well as psychological disturbances from chronic pain.

It has been shown that US military personnel develop osteoarthritis of the knee at rates up to 50% higher than age matched civilian counterparts.1 A recent retrospective review of total knee arthroplasty in active duty service members under age 50 years, found that nearly 75% of the knees had experienced prior ligamentous, meniscal, or chondral injury prior to arthroplasty, compared to 9.8% observed in a high volume civilian adult reconstruction practice.2 They reported an average of 17.2 years from injury to arthroplasty in this population.3 There is a paucity of data examining the prevalence of post-traumatic osteoarthritis of other major joints, including the hip, shoulder, and ankle, in the military population, but is believed to be significant.
    
Chronic pain and opioid abuse are endemic in our country; the military and veteran communities are not immune from these issues. Traumatic brain injuries, post-concussive syndrome, post traumatic stress disorder, and behavioral health disorders, combined with the stigma attached to these issues, complicates the diagnosis and treatment of chronic pain in this patient group. Chronic pain due to musculoskeletal pain and combat-related polytrauma pain has been reported in up to 50% of the Veteran community and 44% among US service members after combat deployment compared to 26% in the general population.4

Extremity trauma resulting from high-energy explosives in Iraq and Afghanistan was common; 54% of evacuated wounded service members had extremity injures. More than one-quarter (26%) of all extremity war injuries involved fractures; 82% were open.5 The Military Extremity Amputation/Limb Salvage (METALS) Study found that participants with a unilateral or bilateral amputation had significantly better SMFA functional outcomes than those whose limbs had been salvaged. This is contrary to what was found in the civilian LEAP study, where there were no significant differences in outcomes at two or seven years post injury.5 Amputees were nearly three times as likely to be engaged in a vigorous sport or recreational activity. However, the percentage working/on active duty or in school was the same, as were the rates of depression.5 Future key challenges in this population after discharge from military service include: access to care, prosthetic maintenance, activities of daily living, vocational rehabilitation, and quality of life.

The burden of musculoskeletal disease on the military population is vast and spans across the service member’s lifetime. The physical nature demanded by military requirements places its Active Duty and Reserve members at risk of suffering from acute, chronic, and life-long musculoskeletal conditions. Great strides have been made in developing ways to prevent and identify these issues sooner, but much work remains to be done.

  • 1. Cameron KL, Hsiao MS, Owens BD, Burks R, Svoboda SJ. Incidence of physician-diagnosed osteoarthritis among active duty United States military service members. Arthritis Rheum 2011; 63(10):2974-2982.
  • 2. Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA. Post traumatic osteoarthritis: a first estimate of incidence, prevalence and burden of disease. J Orthop Trauma 2006; 20(10):739-744.
  • 3. Murtha AS, Johnson AE, Buckwalter JA, et al. Total knee arthroplasty for posttraumatic osteoarthritis in military personnel under age 50. J Orthop Res 2017; 35:677-681.
  • 4. Toblin RL, Mack KA, Perveen G, Paulozzi LJ. A population-based survey of chronic pain and its treatment with prescription drugs. Pain 2011; 152(6):1249-1255. doi: 10.1016/j.pain.2010.12.036. Epub 2011 Mar 11.
  • 5. a. b. c. Doukas WC, Hayda RA, Frisch HM, et al. The military extremity trauma amputation/limb salvage (METALS) study. JBJS AM 2013;95:138-145.

Edition: 

  • Fourth Edition

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