Background and purposeThere is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA.Patients and methodsThis prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0–2) and severe OA (KL 3–4) using a multivariate linear regression model.ResultsAdjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS “Activities of daily living”, “Pain”, and “Symptoms”, and SF36 physical component summary (“PCS”) scale. In TKA, we found no such associations.InterpretationThe decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA.

The aim of this study was to measure return to work and duration until return to work in patients undergoing total hip or knee arthroplasty (THA or TKA). This prospective study included patients under 65 years of age, undergoing THA or TKA, who provided information on their work status preoperatively (paid work yes/no and working hours) and 1 year thereafter (paid work yes/no, working hours and time until return to work). Seventy-one THA and 64 TKA patients had a paid job preoperatively. The employment rates 1 year postoperatively were 64/71 (90 %) after THA and 53/64 (83 %) after TKA. Of those who returned to work, 9/64 (14 %) of THA patients and 10/53 (19 %) of TKA patients worked less hours than preoperatively [mean decrease of 16 (SD 11.5) and 14 (SD 13.0) hours, respectively]. The mean time to return to work was 12.5 (SD 7.6) and 12.9 (SD 8.0) weeks in THA and TKA, respectively. The majority of working patients who underwent THA or TKA returned to work, after approximately 12 weeks. A considerable proportion of the patients returning to work worked less hours than preoperatively. More research into patients who do not return or decrease their working hours is needed.

Background A substantial proportion of patients undergoing Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA) is of working age at the time of surgery. Although it is found that the majority of working patients return to work after surgery, the literature on duration until return to work and the impact of surgery on the amount of working hours in patients undergoing THA or TKA is scanty. Objectives The aim of this study was to measure duration until return to work and the impact of surgery on working hours in patients undergoing THA or TKA. Methods This study on work was part of a prospective cohort study on the outcomes of THA and TKA surgeries. This study included patients under 65 years of age, undergoing THA or TKA, who provided information on their work status before and one year after surgery. Assessments included a questionnaire on work status (yes/no), working hours per week and time to return to work. Comparisons of working hours before and after surgery were done with the Wilcoxon signed-rank test. Results Seventy-five of 122 THA (62%) and 70 of 120 TKA patients (59%) who were under 65 years had a paid job before surgery. The mean numbers of working hours per week were 32.3 (SD 13.4) in the THA group and 31.0 (SD 12.6) in the TKA group. Absence of work in relation to hip-or knee complaints during the year before surgery was reported by 19 (25%) and 19 (27%) of the employed patients with THA and TKA, respectively. The employment rates one year postoperatively were 66/75 (88%) after THA and 60/70 (86%) after TKA. The mean time to return to work was 12.5 (SD 7.5) and 12.9 (SD 7.8) weeks after THA and TKA, respectively. After 1 year, 17/66 (30%) of the patients with THA and 19/60 (32%) of patients with TKA worked less hours postoperatively as compared to preoperatively. In these patients, the number of working hours decreased significantly, with a mean difference of -14.4 hours (95% CI -19.5; -9.8) in the THA group and of -14.7 hours (95% CI -20.7; -9.4) in the TKA group (both p=0.002, Wilcoxon signed-rank test). Conclusions The majority of patients who had a paid job before surgery returned to work after THA and TKA, after approximately 12 weeks. Thirty % of the patients who returned to work, worked less hours than preoperatively. Given the increasing numbers of working patients undergoing THA or TKA more research into patients who do not return or decrease their working hours is needed. References Tilbury C. et al. Rheumatology 2013 Nov 23. [Epub ahead of print] Kuijer PP et al. J Occup Rehabil 2009;19(4):375-381. Kievit A.J. et al. Journal of Arthroplasty 2014; 10.1016 Acknowledgements Special thanks to the Annafonds|NOREF for their financial support. Disclosure of Interest : C. Tilbury Grant/research support: Anna Fonds/NOREF, C. Leichtenberg: None declared, R. Tordoir: None declared, M. Holtslag: None declared, S. Verdegaal: None declared, R. Nelissen: None declared, T. Vliet Vlieland: None declared DOI 10.1136/annrheumdis-2014-eular.2940