Pre-operative absence from work is a predictor for the return to work after arthroplasty

For patients who undergo total hip or total knee arthroplasty, the most significant predictor of incomplete or no return to work is preoperative absence from employment, new research shows. Preoperative absence from work is a potentially modifiable factor and modification could prevent productivity loss.

Of patients undergoing total hip or total knee arthroplasty, 15% to 45% are of working age. Most return to work after surgery, but some experience a reduction in work hours, and 5% to 30% do not return at all.

A study by Lichtenberg identified the determinants of incomplete or no return to work 1 year after surgery. Leichtenberg presented results from the prospective cohort study here at the 16th European Federation of National Associations of Orthopaedics and Traumatology Congress in Prague.

Of the 123 study participants, 67 underwent total hip arthroplasty and 56 underwent total knee arthroplasty. All were younger than 65 years and had a paid job at the time of surgery.

Sociodemographic characteristics were matched in the hip and knee groups using pain, other symptoms, function in daily living, function in sport and recreation, and quality of life subscores of the Hip Disability and Osteoarthritis Outcome Score or the Knee Injury and Osteoarthritis Outcome Score.

Patients were evaluated before surgery and 1 year after surgery. The primary outcome — return to work 1 year after surgery — was classified as complete, incomplete, or not at all.

The researchers categorized the physical demands of each patient's work as light, medium, or heavy. The rate of patients with physical work categorized as light was lower in the hip group than in the knee group (70% vs 87%).

 Work Characteristics and Outcomes

Variable	Hip Group, %	Knee Group, %
Characteristic
Self-employed	18	15
On workers' compensation the month before surgery	8	11
Need for work adaptations	24	35
Absence from work due to pain	32	32
Work at 1 year
Complete	79	71
Incomplete	13	18
Not at all	8	11

Preoperative absence from work was the only factor associated with no or incomplete return to work in both the hip group (odds ratio [OR], 8.6; 95% confidence interval [CI], 1.9 - 39.0) and the knee group (OR, 4.2; 95% CI, 1.0 - 17.1).

In the hip group, self-employment was strongly associated with no or incomplete return to work (OR, 7.6; 95% CI, 1.5 - 39.8), as was a higher Hip Disability and Osteoarthritis Outcome Score.

A return-to-work appears completely dependent on the insurance system in the specific country. In Sweden, from a financial income standpoint, it doesn't matter if you go back to work; you would be pretty well off on public support. In the United States, it is not that way. Patients were not asked for the reasons why they stopped working after surgery, which is one of the limitations of the study.

However, despite this, the researchers conclude that the proportion of hip and knee patients not returning to work full time is substantial, and that the only predictor of this is preoperative absence from work, which can be changed. 

Leichtenberg, Malchau: More Could Return to Work After Joint Surgery. 16th European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Congress. Presented May 27, 2015.