Return to Work after Primary Total Knee Arthroplasty under the Age of 65 Years: A Systematic Review

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).

Implementation of Back At work After Surgery (BAAS): a feasibility study of an intergrated pathway for improved return to work after knee arthroplasty

“…To ensure good external validity, we also advise this study to be a multicenter study to overcome bias introduced by the clinical involvent of the primary researcher. In comparison to other studies among working age patients with KA, the present patient characteristics were similar in terms of age, gender and educational level [6,15]. An important prognostic factor for RTW for patients with KA, are the physical job demands [15].…”

“…Physical therapy provided by primary care physical therapy outside the hospital is also in line with the right care in the right place, a main topic on the agenda of the Dutch National Health Care Institute (https://english.zorginstituutnederland.nl/). To increase the dose delivered, we advise to train the orthopedic surgeons to inform patients better about return to work after surgery and relevant prognostic factors, in line with recent studies[8, 15,16]. Future studies should prove whether these measures indeed improved the feasibility.…”

“…The orthopedic surgeon provided preoperative information about returning to work after surgery in terms of expected time to RTW and the known prognostic factors female gender, high patient report workrelatedness of knee symptoms, high physical work demands, high BMI and more preoperative sick absence from work [15,16]. Next, the case manager medical (CMM, physical therapist working in the hospital) contacted the occupational physician to inform him about the participation of the patient in this clinical pathway.…”

Sickness absence and return to work among employees with knee osteoarthritis with and without total knee arthroplasty: a prospective register linkage study among Finnish public sector employees

“…Even though the proportion of women was much higher than that of men, the number of men was high enough for comparison. Moreover, the previous studies have shown contradictory sex related results on the time to RTW among TKA patients (20,35).…”

Return to Work Following Knee Arthroplasty

“…Furthermore, patients who had a slower return to work often reported that comorbidities, especially musculoskeletal like low back pain or OA affecting other joints, prevented their RTW even when the surgical outcome was positive [40]. However, the most recent review on prognostic factors for return to work concluded that based on 14 studies and 3073 patients, the most important prognostic factors associated with a slower or no RTW were a more physically demanding job and preoperative absence from work [41].…”