Which patients do not return to work after total knee arthroplasty?

P Paul F M Kuijer,Marco J M Hoozemans,Truus Hooiveld,Monique H W Frings-Dresen,Rutger C I Van Geenen,Arthur J Kievit,Leendert Blankevoort,Matthias U Schafroth,Thijs M J Pahlplatz

doi:10.1007/s00296-016-3512-5

P Paul F M Kuijer, Marco J M Hoozemans + Show 7 more

Open Access

https://doi.org/10.1007/s00296-016-3512-5

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Abstract

Total knee arthroplasty (TKA) is increasingly being performed among working patients suffering from knee osteoarthritis. Two out of ten patients do not return to work (RTW) after TKA. Little evidence is available about these patients to guide clinicians. Therefore, this study investigates patients’ characteristics associated with no RTW. A multicenter retrospective cohort study was performed among working patients having undergone a primary TKA during 2005–2010. The following preoperative characteristics were assessed: age at surgery, sex, comorbidity, body mass index (BMI), preoperative sick-leave duration, patient-reported work-relatedness of knee symptoms, and physical job demands. In addition, the Knee injury and Osteoarthritis Outcome Scores (KOOS) after TKA were assessed. Backward stepwise logistic regression analyses were performed to predict no RTW. Seven hundred and sixty-four patients were approached, and 558 patients (73 %) responded. One hundred and sixty-seven met the inclusion criteria and 46 did not RTW. A preoperative sick-leave duration >2 weeks (OR 12.5, 90 % CI 5.0–31.5) was most strongly associated with no RTW. Other associations found were: female sex (OR 3.2, 90 % CI 1.3–8.2), BMI ≥ 30 (OR 2.8, 90 % CI 1.1–7.1), patient-reported work-relatedness of knee symptoms (OR 5.3, 90 % CI 2.0–14.1), and a physically knee-demanding job (OR 3.3, 90 % CI 1.2–8.9). Age and KOOS were not associated with no RTW. Especially obese female workers, with a preoperative sick-leave duration >2 weeks, who perform knee-demanding work and indicate that their knee symptoms are work-related have a high chance for no RTW after TKA. These results stress the importance of a more timely referral for work-directed care of patients at risk for no RTW after TKA.

Highlights

Total knee arthroplasty (TKA) is highly effective in treating pain and loss of function caused by knee osteoarthritis (OA) [1]
This study showed that Knee injury and Osteoarthritis Outcome Scores (KOOS) pain, symptoms, activities of daily living (ADL), and Sport/Rec were not associated with no return to work (RTW) after TKA
Clinicians should be aware that proxies for participating in work go beyond outcomes like pain or function [6]

Summary

Introduction

Total knee arthroplasty (TKA) is highly effective in treating pain and loss of function caused by knee osteoarthritis (OA) [1]. In the USA, more than 50 % of the primary TKA patients are younger than 65 years old by 2016 [2]. In the Netherlands in 2013, the incidence of TKA surgery among 45- to 64-year-old patients more than tripled between 1995 and 2005 [3]. The prediction for the Netherlands is that the number of patients receiving TKA will increase by about 300 % to 57,900 annually in 2030 [3]. An increasing number of knee OA patients will need to be able to RTW after TKA surgery. Based on data from 11 studies, 307 out of 1417 patients working before TKA surgery (22 %) did not RTW [5, 6]. Given the increasing numbers of TKAs performed among working knee OA patients worldwide, this ratio reflects a large group of workers

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