Incidence of Overuse Musculoskeletal Injuries in Military Service Members With Traumatic Lower Limb Amputation

Objective: To describe the incidence of overuse musculoskeletal injuries in service members with combat-related lower limb amputation. Design: Retrospective cohort study. Setting: Military treatment facilities. Participants: Service members with deployment-related lower limb injury (N=791): 496 with a major lower limb amputation and 295 with a mild lower limb injury. Interventions: Not applicable. Main Outcome Measures: The outcomes of interest were clinical diagnosis codes (International Classification of Diseases–9th Revision) associated with musculoskeletal overuse injuries of the lumbar spine, upper limb, and lower limb regions 1 year before and 1 year after injury. Results: The overall incidence of developing at least 1 musculoskeletal overuse injury within the first year after lower limb amputation was between 59% and 68%. Service members with unilateral lower limb amputation were almost twice as likely to develop an overuse lower or upper limb injury than those with mild combat-related injury. Additionally, service members with bilateral lower limb amputation were more than twice as likely to develop a lumbar spine injury and 4 times more likely to develop an upper limb overuse injury within the first year after amputation than those with mild combat-related injury. Conclusions: Incidence of secondary overuse musculoskeletal injury is elevated in service members with lower limb amputation and warrants focused research efforts toward developing preventive interventions.