Background The number of people undergoing Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA) surgery is rising, with a substantial proportion of patients being of working age.
Objectives To describe the duration of return to work in patients undergoing TKA or THA and to determine which factors are associated with returning to work.
Methods A systematic review was performed using a search strategy in various databases until April 2012. All clinical studies concerning patients undergoing TKA and/or THA providing quantitative information on work status before and after surgery were eligible for inclusion. Extracted data included study characteristics, patient characteristics, work status prior to surgery and after surgery and determinants of return to work. Selection of papers and data extraction were done by two investigators independently.
Results The literature search yielded 514 titles and abstracts, with finally 18 studies, published between 1986 and 2011 being selected (4 on TKA, 13 on THA and 1 on both TKA and THA). These studies included 649 patients with TKA and 3633 with THA. Seven studies had a prospective cohort design and 11 a retrospective cohort design. There was a large variety concerning the definition of work status before and after surgery.
In the studies describing return to work, the proportions of patients returning to work ranged between 71% and 83% at 3 to 6 months after TKA (n=2 studies) and between 25% and 95% at 1 to 12 months after THA (n= 6 studies).
The duration of return to work in patients who were working pre-operatively varied from 8.0 to 12.0 weeks after TKA (n=4 studies) and from 1.1-10.5 weeks after THA (n=6 studies). Studies reporting on the determinants of (a faster) return to work after surgery varied largely with respect to their methodology. For TKA determinants were: not receiving a worker’s compensation, having a sense of urgency and positive motivation to return to work, working in a handicap accessible workplace, being female, being self-employed, and having better physical and mental functioning scores (n=1 study). In THA the following factors were associated with (faster) return to work: working pre-operatively, a short duration of sick leave pre-operatively, younger age, doing mental work, having a higher educational level and being male (n=10 studies).
Conclusions This systematic review of the literature shows that the majority of patients who are employed before TKA and THA return to work postoperatively. The rate and speed of return to work appear to be more favorable in THA than in TKA, however comparisons are hampered by large variations in patient selection and measurement methods. Standardization of the selection op patients and measurement of work status in patients undergoing total hip and knee surgery is needed.
Disclosure of Interest None Declared