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In young military populations, the prevalence of radiographic hip osteoarthritis is higher than in the general population, and the risk of incidence and progression is significantly increased by specific injuries like lower limb loss and hip trauma rather than combat injury alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 2, 2025Osteoarthritis and Cartilage Open2 citationsOpen Access

Prevalence, incidence, and progression of hip osteoarthritis in a young military population: The ADVANCE cohort study

FWFraje Watson OOOliver O’Sullivan ABAlexander N. Bennett

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Abstract

Objective: Prevalence of hip osteoarthritis (OA) is rarely reported in young populations (e.g., military). We will report the prevalence of hip OA in a young military cohort and investigate the relationship between injury and progression/incidence. Design: ADVANCE is a prospective cohort study comparing physical and psychosocial outcomes in 1145 men who served in Afghanistan including 579 men with combat injury (Exposed) who were frequency-matched to 566 controls (Unexposed). The Exposed group was sub-divided into hip injured (Exp-H), lower limb amputation (Exp-A) and other (Exp-NA). Kellgren-Lawrence (KL) scores of pelvic radiographs and Non-Arthritic Hip Score (NAHS) questionnaires were collected across two waves (Baseline and Follow-up). Prevalence at Baseline (KL ≥ 2), progression (KL ≥ 1 at Baseline, KL ≥ 2 at Follow-up) and incidence (KL0 at Baseline, KL ≥ 2 at Follow-up) at Follow-up were reported and compared between groups for KL and NAHS. Results: Baseline prevalence of radiographic hip OA was 8.5 % and 4.4 % in the Exposed and Unexposed groups, respectively. Exp-A and Exp-H groups had 3.88 (95%CI:2.27-6.63) and 7.18 (95%CI:3.44-14.98 times increased risk for radiographic hip OA than Unexposed. Exp-A and Exp-H had a 2.15 (95%CI:1.22-3.80) and 3.28 (95%CI:1.42-7.59) times increased radiographic progression risk, compared to Unexposed. Risk of NAHS Progression and Incidence were not significantly different between groups. Conclusion: Radiographic hip OA prevalence is higher in a young military population than in a similarly aged general population. Combat injury alone may not increase hip OA prevalence; but hip and lower limb loss injuries do. Progression risk is highest in those with hip or limb loss injuries.

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