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Osteoarthritis in the UK Armed Forces: a review of its impact, treatment and future research
  1. Oliver O'Sullivan1,2,
  2. F P Behan3,
  3. R J Coppack1,4,
  4. J Stocks2,
  5. S Kluzek2,4,
  6. A M Valdes2,5 and
  7. A N Bennett1,6
  1. 1Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
  2. 2Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
  3. 3Department of Bioengineering, Imperial College London, London, UK
  4. 4Centre for Sport, Exercise and Osteoarthritis Research, Versus Arthritis, Nottingham, UK
  5. 5Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
  6. 6National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
  1. Correspondence to Maj Oliver O'Sullivan, Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK; oliver_osullivan{at}


Within the UK Armed Forces, musculoskeletal injuries account for over half of all medical downgrades and discharges. Data from other Armed Forces show that osteoarthritis (OA), more common in military personnel, is likely to contribute to this, both in its primary form and following injury (post-traumatic OA, PTOA), which typically presents in the third or fourth decade. OA is not a progressive ‘wear and tear’ disease, as previously thought, but a heterogenous condition with multiple aetiologies and modulators, including joint damage, abnormal morphology, altered biomechanics, genetics, low-grade inflammation and dysregulated metabolism. Currently, clinical diagnosis, based on symptomatic or radiological criteria, is followed by supportive measures, including education, exercise, analgesia, potentially surgical intervention, with a particular focus on exercise rehabilitation within the UK military. Developments in OA have led to a new paradigm of organ failure, with an emphasis on early diagnosis and risk stratification, prevention strategies (primary, secondary and tertiary) and improved aetiological classification using genotypes and phenotypes to guide management, with the introduction of biological markers (biomarkers) potentially having a role in all these areas. In the UK Armed Forces, there are multiple research studies focused on OA risk factors, epidemiology, biomarkers and effectiveness of different interventions. This review aims to highlight OA, especially PTOA, as an important diagnosis to consider in serving personnel, outline current and future management options, and detail current research trends within the Defence Medical Services.

  • Adult orthopaedics
  • Musculoskeletal disorders

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  • Contributors OOS conceived the manuscript and prepared the first draft. FPB, RJC, JS, SK, AMV and ANB all provided expert input and critical review on subsequent drafts. All authors approved the final version. OOS acts as the guarantor.

  • Funding This work was supported by a grant from Versus Arthritis (21076) and funding from the UK Ministry of Defence (2122.030).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.