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Hip and knee replacement as a proxy measure for lower limb osteoarthritis in Scottish military veterans
  1. Beverly P Bergman,
  2. D F Mackay and
  3. J P Pell
  1. Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Beverly P Bergman, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK; Beverly.bergman{at}


Introduction Physical activity is an important component of military training. Although injuries and musculoskeletal disorders are the most common cause of medical retirement from the Armed Forces, the long-term risk of lower limb osteoarthritis in veterans is unknown. We used data on hip and knee replacement in Scottish military veterans as a proxy measure.

Methods Retrospective cohort study of 78 000 veterans born between 1945 and 1995 and a comparison group of 253 000 non-veterans, matched for age, sex and area of residence, followed up for up to 37 years, using survival analysis to examine the risk of hip and knee replacement.

Results Veterans were significantly less likely to undergo hip replacement than non-veterans, Cox proportional HR 0.87, 95% CI 0.80 to 0.95, p<0.001. There was no significant difference between veterans and non-veterans in respect of knee replacement, HR 1.02, 95% CI 0.94 to 1.11, p=0.643, and there was no difference in the ages at which veterans and non-veterans underwent joint replacement. People who had served for longest in the military had similar risk to those with the shortest service.

Conclusions Based on the likelihood of undergoing joint replacement surgery in later life, we found no evidence of a positive association between military service and an increased risk of lower limb osteoarthritis.

  • rheumatology
  • rehabilitation medicine
  • epidemiology
  • musculoskeletal disorders

Data availability statement

No data are available. The study remains in progress and the data are not currently available for sharing.

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Data availability statement

No data are available. The study remains in progress and the data are not currently available for sharing.

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  • Contributors BPB conceived the idea and designed the study, with advice from JPP and DFM. BPB carried out the data analysis, which was overseen by DFM, and interpreted the findings. BPB wrote the first draft of the report, which was critically reviewed and edited by all authors. BPB revised the article in response to the Reviewers’ feedback, and all authors approved the final article.

  • Funding ‘Trends in Scottish Veterans Health’ is funded by a grant from the Forces in Mind Trust, grant no. FiMT17/1101UG.

  • Disclaimer The views and opinions expressed are those of the authors and do not necessarily reflect those of the funders. The funding body had no role in the study design, analysis, interpretation of data or in writing the manuscript. Neither the Army nor the Ministry of Defence had any input to this paper, and the views and opinions expressed are solely those of the authors.

  • Competing interests BPB is a military veteran and Honorary Civilian Consultant Advisor (Army) in Veterans’ Health and Epidemiology. No other interests are declared by the authors.

  • Provenance and peer review Not commissioned; externally peer reviewed.