Incidence and outcomes of knee and hip joint replacement in veterans and civilians.

BACKGROUND: This article describes the incidence of total knee and hip replacement, and compares post-surgery health status outcomes in veterans and civilians.

METHODS: The numbers of male veterans and civilians who had a knee and/or a hip replacement in South Australia (1994-2002) were obtained. Standardized morbidity ratios, and odds ratios for age group by veteran/civilian interactions, were calculated. Presurgery and 1-year post-surgery Medical Outcomes Short Form (36) Health Survey, Knee Society and Harris hip scores were completed. Independent samples t-tests were used to compare presurgery scores. ancova models were used to determine any differences between veterans and civilians post-surgery.

RESULTS: For veterans, standardized morbidity ratios were 0.987 and 0.715 for knee and hip replacements, respectively (P < 0.0001). Veterans' odds ratios for knee and hip replacements were significantly lower in the 65- to 74-year age group (P < 0.001), similar in the 75- to 84-year and above 85-year age groups for hip replacement, but significantly higher in the above 85-year age group for knee replacement (P < 0.001). Presurgery, veterans reported significantly lower scores (P < 0.003) for knee function. After knee replacement, veterans reported significantly lower Medical Outcomes Short Form (36) Health Survey scores for bodily pain, physical functioning, role - physical, role--emotional, social functioning and physical component summary (P < 0.033). Significantly lower physical functioning, role--physical and physical component summary scores (P < 0.02) were reported by veterans post-surgery for hip replacement.

CONCLUSION: Veterans are delaying joint replacement. Presurgical knee function is worse in veterans. Post-surgery, the veterans are worse off in a number of health status outcomes.