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Peters MCWM, Pronk Y, Brinkman JM. Eight of ten patients return to daily activities, work, and sports after total knee arthroplasty. World J Orthop 2024; 15:608-617. [PMID: 39070937 PMCID: PMC11271699 DOI: 10.5312/wjo.v15.i7.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Besides return to work (RTW) and return to sports (RTS), patients also prefer to return to daily activities (RTA) such as walking, sleeping, grocery shopping, and domestic work following total knee arthroplasty (TKA). However, evidence on the timelines and probability of patients' RTA is sparse. AIM To assess the percentage of patients able to RTA, RTW, and RTS after TKA, as well as the timeframe and influencing factors of this return. METHODS A retrospective cohort study with prospectively collected data was conducted at a medium-sized Dutch orthopedic hospital. Assessments of RTA, RTW, and RTS were performed at 3 mo and/or 6 mo following TKA. Investigated factors encompassed patient characteristics, surgical characteristics, and preoperative patient-reported outcomes. RESULTS TKA patients [n = 2063; 66 years old (interquartile range [IQR]: 7 years); 47% male; 28 kg/m2 (IQR: 4 kg/m2)] showed RTA ranging from 28% for kneeling to 94% for grocery shopping, with 20 d (IQR: 27 d) spent for putting on shoes to 74 d (IQR: 57 d) for kneeling. RTW rates varied from 62% for medium-impact work to 87% for low-impact work, taking 33 d (IQR: 29 d) to 78 d (IQR: 55 d). RTS ranged from 48% for medium-impact sports to 90% for low-impact sports, occurring within 43 d (IQR: 24 d) to 90 d (IQR: 60 d). One or more of the investigated factors influenced the return to each of the 14 activities examined, with R² values ranging from 0.013 to 0.127. CONCLUSION Approximately 80% of patients can RTA, RTW, and RTS within 6 mo after TKA. Return is not consistently influenced by predictive factors. Results help set realistic pre- and postoperative expectations.
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Affiliation(s)
| | - Yvette Pronk
- Department of Research, Kliniek ViaSana, Mill 5451 AA, Netherlands
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Kangas P, Soini S, Pamilo K, Kervinen V, Kinnunen ML. Return to Work Following Hip or Knee Arthroplasty: A One-Year Prospective Cohort Study in Participants with Direct Referral from Hospital to Occupational Health Care Services. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10218-7. [PMID: 38896401 DOI: 10.1007/s10926-024-10218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE In a new Finnish Coordinated Return to Work (CRTW) model, patients are referred to occupational health care after hip or knee arthroplasty. This study evaluated the CRTW model's effect on return to work (RTW), activities used in occupational health care and in the workplace, and the patient- and work-related factors affecting early RTW. METHODS 209 participants with occupational health care service underwent primary hip (THA) or total/unicondylar knee (KJA) arthroplasty and completed self-reported questionnaires after arthroplasty and at time of RTW. Factors affecting RTW, and the roles of occupational health care and the workplace in RTW were evaluated. Time to RTW was determined as days between the arthroplasty and RTW. RESULTS Mean time to RTW was 69 days after THA and 87 days after KJA. For easing RTW, work arrangements were made for 56% of the participants. The most utilized adjustments of work were enabling remote work and arranging limitations in work tasks. Participants with earlier RTW had lower physical workload, higher professional status and motivation to work, less pre-arthroplasty sick leave, and more positive personal expectations about the time to RTW compared to participants with later RTW (p < 0.001 for all). The linear regression and dominance analyses showed participants' own expectations and pre-arthroplasty sick leave as the strongest factors affecting time to RTW. CONCLUSIONS The CRTW model seems to shorten time to RTW after THA and KJA. Occupational health care and workplace play important roles in supporting RTW. Patients' own expectations should be noted when giving pre-arthroplasty information.
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Affiliation(s)
- Pauliina Kangas
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Finland.
| | - Satu Soini
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Visa Kervinen
- Terveystalo Ltd, Occupational Health Services, Jyväskylä, Finland
- The Wellbeing Services County of Central Finland, Jyväskylä, Finland
| | - Marja-Liisa Kinnunen
- The Wellbeing Services County of Central Finland, Jyväskylä, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
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Lavikainen P, Heiskanen J, Jalkanen K, Lehtimäki AV, Vehkala S, Kangas P, Husman K, Vohlonen I, Martikainen J. Effectiveness of the Coordinated Return to Work model after orthopaedic surgery for lumbar discectomy and hip and knee arthroplasty: a register-based study. Occup Environ Med 2024; 81:150-157. [PMID: 38331568 PMCID: PMC10958326 DOI: 10.1136/oemed-2023-109276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES This study examined the effectiveness of an individualised Coordinated Return to Work (CRtW) model on the length of the return to work (RTW) period compared with a standard prescription of 2-3 months RTW during recovery after lumbar discectomy and hip and knee arthroplasty among Finnish working-age population. METHODS Cohorts on patients aged 18-65 years old with lumbar discectomy or hip or knee arthroplasty were extracted from the electronic health records of eight Finnish hospital districts in 2015-2021 and compiled with retirement and sickness benefits. The overall effect of the CRtW model on the average RTW period was calculated as a weighted average of area-specific mean differences in RTW periods between 1 year before and 1 year after the implementation. Longer-term effects of the model were examined with an interrupted time series design estimated with a segmented regression model. RESULTS During the first year of the CRtW model, the average RTW period shortened by 9.1 days (95% CI 4.1 to 14.1) for hip arthroplasty and 14.4 days (95% CI 7.5 to 21.3) for knee arthroplasty. The observed differences were sustained over longer follow-up times. For lumbar discectomy, the first-year decrease was not statistically significant, but the average RTW had shortened by 36.2 days (95% CI 33.8 to 38.5) after 4.5 years. CONCLUSIONS The CRtW model shortened average RTW periods among working-age people during the recovery period. Further research with larger samples and longer follow-up times is needed to ensure the effectiveness of the model as a part of the Finnish healthcare system.
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Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Heiskanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Kari Jalkanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Saara Vehkala
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Kaj Husman
- University of Eastern Finland, Kuopio, Finland
| | - Ilkka Vohlonen
- Department of Public Health, University of Eastern Finland, Kuopio, Finland
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Tan FBN, Tan CMP, Wong TAKW, Zhang W, Kunnasegaran R. Return to work following knee arthroplasty: a retrospective review in urban Asian population. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:397-403. [PMID: 37552287 DOI: 10.1007/s00590-023-03662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND An increasing number of working adults undergo knee arthroplasty in Singapore. There is limited data concerning Southeast Asian patients returning to work (RTW) following knee replacement surgery. Our aim was to identify and study factors influencing patients RTW following total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). METHODS Patients who underwent TKA or UKA between August 2017 and March 2020 in our center were included in this study. Outcomes include RTW and duration prior to RTW. RESULTS 441 patients underwent TKA (295 women, 146 men, mean age 67.3 years) and 69 underwent UKA (48 women, 21 men, mean age 61.1 years). Patients who underwent TKA returned to work earlier (mean 83.7 ± 27.1 days) compared to UKA (mean 94.4 ± 42.3 days). 90.0% of TKA patients RTW compared to 95.5% who underwent UKA. Of patients who RTW, 94.3% of the TKA group returned to employment of the same nature compared to 92.9% of UKA patients. Patients who RTW were of a younger age (p = 0.03), white collared workers (p = 0.04), and had independent preoperative ambulatory status (p < 0.01). CONCLUSION Younger and independently ambulating patients may have better capacity for rehabilitation and RTW post arthroplasty surgery.
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Affiliation(s)
- Fiona Bei Na Tan
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore.
| | - Cheryl Marise Peilin Tan
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | | | - Wei Zhang
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Remesh Kunnasegaran
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
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Van Leemput D, Neirynck J, Berger P, Vandenneucker H. Return to Work after Primary Total Knee Arthroplasty under the Age of 65 Years: A Systematic Review. J Knee Surg 2022; 35:1249-1259. [PMID: 33472262 DOI: 10.1055/s-0040-1722626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A growing number of patients undergoing total knee arthroplasty (TKA) is at working age and need to return to work (RTW) after surgery. The aim of this systematic review is to give an overview of the literature regarding RTW after TKA and beneficial and limiting factors influencing this process. A systematic search in four electronic databases was conducted in November 2019 to identify studies describing RTW after primary TKA in patients aged 65 years or younger. Study characteristics and data on work status before and after surgery were extracted. All studies were assessed for risk of bias. Fourteen studies published between 2009 and 2019 were included in this review, accounting for a total of 3,073 patients. The percentage of patients working after TKA ranged from 36 to 89%, and the fraction of patients working before and returning to work after surgery ranged from 40 to 98%. Mean time of RTW ranged from 7.7 to 16.6 weeks. Most important factors associated with a slower or no RTW were a more physical nature of employment and preoperative absence from work. The majority of patients undergoing TKA returned to work postoperatively. However, comparison between studies is seriously hampered by the wide variation regarding the definition and timeframe used to measure the work status. Therefore, standardized outcome measures for studies investigating RTW after TKA are warranted. We identify this review as level-I evidence (systematic review of level-I and level-II studies).
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Affiliation(s)
- Dries Van Leemput
- Division of Orthopaedics, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Jef Neirynck
- Division of Orthopaedics, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Pieter Berger
- Division of Orthopaedics, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Hilde Vandenneucker
- Division of Orthopaedics, Department of Development and Regeneration-Organ Systems Cluster, KU Leuven, University Hospitals Leuven, Belgium, B-3000 Leuven, Belgium
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ARIMAA A, KNIFSUND J, KESKINEN H, KIVIMÄKI M, AALTO V, OKSANEN T, MÄKELÄ K, VAHTERA J, LANKINEN P. Return to work following anterior cruciate ligament reconstruction. Acta Orthop 2022; 93:554-559. [PMID: 35700049 PMCID: PMC9205185 DOI: 10.2340/17453674.2022.3139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Amongst people of working age, the return to work (RTW) after anterior cruciate ligament (ACL) reconstruction is an important marker of success of surgery. We determined when patients are able to return to work after ACL reconstruction and identified factors that are associated with the timing of RTW. PATIENTS AND METHODS We used logistic regression analyses to examine patient-related factors that may be associated with the length of RTW (above vs. below the median 59 days) after arthroscopic ACLR in a large cohort of patients working in the public sector in Finland (n = 803; n = 334 male, n = 469 female; mean age 41 years [SD 8.6]). RESULTS The mean length of RTW was 65 days (SD 41). Higher odds ratios (OR) were observed for age groups 40-49 and ≥ 50 years compared with ≤ 30 years old (OR 2.0, 95% confidence interval 1.3-3.1 and 2.0, 1.2-3.4, respectively); for lower level non-manual and manual work compared with higher level non-manual work (3.0, 2.0-4.3 and 4.9, 3.4-7.0, respectively); and for those who had been on sick leave > 30 days in the preceding year (2.0, 1.4-2.9). Sex, comorbid conditions, preceding antidepressant treatment and concomitant procedures were not associated with the length of RTW. INTERPRETATION Factors associated with prolonged sick leave beyond the median time of 59 days are higher age, lower occupational status, and preoperative sick leaves.
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Affiliation(s)
- Anssi ARIMAA
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
| | - Jani KNIFSUND
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
| | - Heli KESKINEN
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika KIVIMÄKI
- Finnish Institute of Occupational Health, Helsinki, Finland,Department of Epidemiology and Public Health, University College London, London, UK
| | - Ville AALTO
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuula OKSANEN
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Keijo MÄKELÄ
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi VAHTERA
- Department of Public Health, University of Turku, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University Hospital; Turku, Finland
| | - Petteri LANKINEN
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland,Satasairaala Central Hospital, Pori, Finland
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Freitag J, Wickham J, Shah K, Tenen A. Real-world evidence of mesenchymal stem cell therapy in knee osteoarthritis: a large prospective two-year case series. Regen Med 2022; 17:355-373. [PMID: 35411799 DOI: 10.2217/rme-2022-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To evaluate the long-term safety and efficacy of adipose-derived mesenchymal stem cell (ADMSC) therapy in the treatment of knee osteoarthritis (OA). Methods: 329 participants with knee OA underwent intra-articular ADMSC therapy. Participants were followed up for 24 months and were separated based on radiological OA grade. Results: Treatment was well tolerated with no related serious adverse events. All participant groups reported clinically and statistically significant pain improvement. Clinical outcome was not influenced by patients' age or BMI. Conclusion: ADMSC therapy is an effective, safe and long-lasting treatment option for knee OA with the potential to delay total joint replacement. In addition to the observed clinical benefits, ADMSC therapy promises to reduce the global economic burden of OA. Trial registration number: ACTRN12617000638336.
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Affiliation(s)
- Julien Freitag
- Charles Sturt University, Orange, NSW, 2800, Australia.,Magellan Stem Cells, Box Hill, Victoria, 3129, Australia.,Melbourne Stem Cell Centre Research, Box Hill, Victoria, 3129, Australia
| | - James Wickham
- Charles Sturt University, Orange, NSW, 2800, Australia
| | - Kiran Shah
- Magellan Stem Cells, Box Hill, Victoria, 3129, Australia.,Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia
| | - Abi Tenen
- Magellan Stem Cells, Box Hill, Victoria, 3129, Australia.,Melbourne Stem Cell Centre Research, Box Hill, Victoria, 3129, Australia.,Monash University, Monash, Victoria, 3800, Australia
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Laasik R, Lankinen P, Kivimäki M, Neva MH, Aalto V, Oksanen T, Vahtera J, Mäkelä KT. Return to work after lumbar disc herniation surgery: an occupational cohort study. Acta Orthop 2021; 92:638-643. [PMID: 34269643 PMCID: PMC8635580 DOI: 10.1080/17453674.2021.1951010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Lumbar disc herniation is a common surgically treated condition in the working-age population. We assessed health-related risk factors for return to work (RTW) after excision of lumbar disc herniation. Previous studies on the subject have had partly contradictory findings.Patients and methods - RTW of 389 (n = 111 male, n = 278 female; mean age 46 years, SD 8.9) employees who underwent excision of lumbar disc herniation was assessed based on the Finnish Public Sector Study (FPS). Baseline information on occupation, preceding health, and health-risk behaviors was derived from linkage to national health registers and FPS surveys before the operation. The likelihood of RTW was analyzed using Cox proportional hazard univariable and multivariable modelling.Results - 95% of the patients had returned to work at 12 months after surgery, after on average 78 days of sickness absence. Faster RTW in the univariable Cox model was associated with a small number of sick leave days (< 30 days) before operation (HR 1.3, 95% CI 1.1-1.6); high occupational position (HR 1.6, CI 1.2-2.1); and age under 40 years (HR 1.5, CI 1.1-1.9). RTW was not associated with sex or the health-related risk factors obesity, physical inactivity, smoking, heavy alcohol consumption, poor self-rated health, psychological distress, comorbid conditions, or purchases of pain or antidepressant medications in either the univariable or multivariable model.Interpretation - Almost all employees returned to work after excision of lumbar disc herniation. Older age, manual job, and prolonged sick leave before the excision of lumbar disc herniation were risk factors for delayed return to work after the surgery.
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Affiliation(s)
- Raul Laasik
- Department of Orthopaedics and Trauma, Tampere University Hospital, Tampere, Finland
| | - Petteri Lankinen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland;,Satakunta Central Hospital, Pori, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland;,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland;,Department of Epidemiology and Public Health, University College London, London, UK
| | - Marko H Neva
- Department of Orthopaedics and Trauma, Tampere University Hospital, Tampere, Finland
| | - Ville Aalto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki, Finland;,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, and Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Keijo T Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland;,Correspondence: Keijo T Mäkelä Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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9
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Hah JM, Lee E, Shrestha R, Pirrotta L, Huddleston J, Goodman S, Amanatullah DF, Dirbas FM, Carroll IR, Schofield D. Return to work and productivity loss after surgery: A health economic evaluation. Int J Surg 2021; 95:106100. [PMID: 34600123 PMCID: PMC8604782 DOI: 10.1016/j.ijsu.2021.106100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/27/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to identify preoperative psychosocial factors associated with return-to-work (RTW) and the associated cost of productivity loss due to work absenteeism following surgery. Research demonstrates a high economic burden from productivity loss after surgery, but the comparative cost of productivity loss relative to income across different operations has not been examined. MATERIALS AND METHODS A mixed surgical cohort recruited for a randomized controlled trial were prospectively followed for up to two years following surgery with daily phone assessments to three months, weekly assessments thereafter to six months, then monthly assessments thereafter to determine RTW status, opioid use and pain. RESULTS 183 of 207 (88.3%) patients in paid employment prior to surgery, who provided at least one day of follow-up, were included in this analysis. The average cost of productivity loss due to work absenteeism was $13 761 (median $9064). Patients who underwent total knee replacement incurred the highest income loss. Medical claims filed before surgery were significantly associated with relative income loss (AOR 5.09; 95% CI 1.73-14.96; p < 0.01) and delayed postoperative RTW. Elevated preoperative PTSD symptoms were associated with delayed RTW (HR 0.78; 95%CI 0.63-0.96; p-value = 0.02) while male gender (HR 1.63; 95%CI 1.11-2.38; p-value = 0.01) was associated with faster postoperative RTW. CONCLUSION Surgery places a high economic burden on individuals due to postoperative productivity loss. Multidisciplinary approaches, such as pathways, that facilitate the operation and recovery may mitigate the economic consequences for patients, employers, and the healthcare system.
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Affiliation(s)
- Jennifer M Hah
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA Centre for Economic Impacts of Genomic Medicine, Macquarie University, Sydney, NSW, Australia Stanford Systems Neuroscience and Pain Lab, Stanford University, Stanford, CA, USA Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA Department of Orthopaedic Surgery and (by courtesy) Bioengineering, Stanford University, Stanford, CA, USA Department of General Surgery, Stanford University, Stanford, CA, USA
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10
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Ng HJH, Loke WJ, James Liang Hao W. Return to work after medial unicompartmental knee arthroplasty: A systematic review. Knee 2021; 30:254-266. [PMID: 33975066 DOI: 10.1016/j.knee.2021.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 03/05/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study aims to evaluate the current literature with regard to the average time to and overall rate of return to work (RTW) following medial unicompartmental knee arthroplasty (UKA). METHODS A systematic search was conducted on MEDLINE (Ovid), Embase, Pubmed, CINAHL, Web of Science, Scopus, and the Cochrane Library to identify studies reporting RTW after UKA. Primary outcomes were the rate and time to RTW after UKA. Secondary outcomes were postoperative changes in work intensity, functional scores, and factors affecting RTW. Methodological quality was evaluated using the the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS Seven studies met inclusion criteria. Results were summarized qualitatively. The overall methodological quality of the studies was moderate based on the MINORS score. These studies included 636 patients with 46.5% male. Mean age was 63.1 years. The average rate of RTW was 81.7%. The average time to RTW was 5.4 ± 3.9 weeks (range 1-32 weeks). 81.8% of patients in one study returned to an equally or more physically demanding job, while 83.5% were able to work the same or longer hours postoperatively in another study. Functional scores improved after surgery (n = 6 studies). Factors affecting RTW were postoperative rehabilitation, retirement, and the effects of surgery. CONCLUSION Limited evidence from the included studies with moderate quality suggests that UKA allows patients to RTW faster, with a high rate of RTW and improved functional outcomes. However, consensus definitions and methods of work status analysis are needed for future studies.
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Affiliation(s)
- Hannah Jia Hui Ng
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
| | - Wei Jie Loke
- Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
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Hauer G, Smolle M, Zaussinger S, Friesenbichler J, Leithner A, Maurer-Ertl W. Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design. Sci Rep 2021; 11:4968. [PMID: 33654124 PMCID: PMC7925530 DOI: 10.1038/s41598-021-82805-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022] Open
Abstract
Return to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients' RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients' hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7-14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7-14] vs. 11 [7.5-13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.
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Affiliation(s)
- Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Maria Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Sabrina Zaussinger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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No association between preoperative physical activity level and time to return to work in patients after total hip or knee arthroplasty: A prospective cohort study. PLoS One 2019; 14:e0221932. [PMID: 31479493 PMCID: PMC6719850 DOI: 10.1371/journal.pone.0221932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/19/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose It is important for patients of working age to resume work after total hip or knee arthroplasty (THA/TKA). A higher preoperative level of physical activity is presumed to lead to a better or faster recovery. Aim is to examine the association between preoperative physical activity (PA) level (total and leisure-time) and time to return-to-work (RTW). Methods A prospective multicenter survey study. Time to RTW was defined as the length of time (days) from surgery to RTW. PA level was assessed with the SQUASH questionnaire. Questionnaires were filled in before surgery and 6 weeks and 3, 6 and 12 months post-surgery. Multiple regression analyses were conducted separately for THA and TKA patients. Results 243 patients were enrolled. Median age was 56 years; 58% had undergone a THA. Median time to RTW was 85 (THA) and 93 (TKA) days. In the multiple regression analysis, neither preoperative total PA level nor leisure-time PA level were significantly associated with time to RTW. Conclusions Preoperative physical activity level is not associated with a shorter time to RTW in either THA or TKA patients. Neither preoperative total PA level nor leisure-time PA level showed an association with time to RTW, even after adjusting for covariates. Trial registry Dutch Trial Register: NTR3497.
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