title: Incidence and outcomes of knee and hip joint replacement in veterans and civilians.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, Flinders University School of Medicine, Flinders Medical Centre and Repatriation General Hospital, Daw Park, SA, Australia. vanessa.wells@rgh.sa.gov.au
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wells
authors.forename: Trevor
authors.initials: T
authors.lastname: Hearn
authors.forename: Adrian
authors.initials: A
authors.lastname: Heard
authors.forename: Kylie
authors.initials: K
authors.lastname: Lange
authors.forename: Wayne
authors.initials: W
authors.lastname: Rankin
authors.forename: Stephen
authors.initials: S
authors.lastname: Graves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D015207:Osteoarthritis, Hip / Q000453:epidemiology / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000601:surgery*; D013021:South Australia / Q000453:epidemiology; D016896:Treatment Outcome; D014728:Veterans