The Armed Services Trauma and Rehabilitation Outcome (ADVANCE) study followed 1,145 men who served in Afghanistan — 579 who sustained combat injuries, matched to 566 who did not. The study collected physical, biological, and psychological data to understand the long-term consequences of serious injury.

ADVANCE provides a rare window into a young, physically active population at known risk of joint problems. It allows researchers to ask not just who develops osteoarthritis, but when, why, and what separates those who do from those who don’t — while they are still relatively young.

To understand how common osteoarthritis actually is in younger people, the team analysed two large datasets in veteran and serving personnel: the Clinical Practice Research Datalink (CPRD), which holds anonymised GP records for around 17.5 million patients across the UK, building on a specific project to explore veteran physical and mental health, and UK military health records.

Comparing veteran and non-veteran populations allows us to estimate how much of the osteoarthritis seen in military personnel reflects the demands of that role, and how much mirrors patterns in the wider population.

Before running new studies, the team mapped what is already known: which biological signals — proteins, enzymes, inflammatory markers — appear in blood or other tissues before osteoarthritis becomes clinically obvious? Reviewing the international evidence base prevents duplication and identifies the gaps in knowledge. We found that blood markers, MRI markers and movement tests can all suggest ways to improve early recognition of osteoarthritis.

Using the ADVANCE study and some of the biomarkers identified in the earlier systematic reviews, studies were undertaken to see if any blood tests could be used to identify and predict osteoarthritis or better understand what is happening within the body during its development.

Proteomics analyses thousands of proteins in a biological sample simultaneously. Lipidomics does the same for fats. Together, they can reveal molecular patterns in blood that may signal early joint damage — well before a person notices pain or imaging shows any visible change.

Samples from the ADVANCE cohort are being analysed to identify signatures that distinguish people who go on to develop osteoarthritis from those who don’t. The goal is markers specific enough to be genuinely useful in a clinical setting, not just scientifically interesting.

Growth plates are areas of developing cartilage near the ends of long bones, present through adolescence and into early adulthood. There is an open question about whether high physical loads at a young age affect how joints develop — and whether this contributes to osteoarthritis risk later. This study will examine structural changes in growth plates in young military personnel, looking for early indicators that might otherwise go unnoticed for years.

Military personnel who work aboard vessels are exposed to prolonged whole-body vibration — a physical stress whose effects on joint health are not well understood. This study uses biomechanical modelling to examine how vibration load travels through the body and what it may do to joints over time. The findings will be relevant beyond the military: vehicle operators, construction workers, and others exposed to sustained vibration may face comparable risks.

Trials testing specific interventions in younger adults, either with established osteoarthritis or at elevated risk. The aim is to build an evidence base that reflects this age group, not one borrowed from research conducted in people two or three decades older. Several interventions are planned, including knee braces, injections into the joint, and app-based holistic programmes.

Research findings only change things if they reach the people who can act on them — and that process is itself studied here. Using surveys, focus groups, and implementation science, this workstream investigates how international best-practice evidence can be consistently adopted in clinical and policy settings, particularly where early-onset osteoarthritis is most common.

The study focuses on what gets in the way of change and what makes adoption of interventions more likely — generating evidence about the implementation process, not just the clinical content. The starting point is understanding which current best-practice evidence is most relevant, and then identifying the barriers and facilitators to putting it into practice for the working-age population in the UK.