title: Which patients do not return to work after total knee arthroplasty?
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.
authors.affiliation: People and Work Outpatient Clinic, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. p.p.kuijer@amc.nl.
authors.forename: P Paul F M
authors.initials: PP
authors.lastname: Kuijer
authors.affiliation: Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Kievit
authors.affiliation: Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Thijs M J
authors.initials: TM
authors.lastname: Pahlplatz
authors.affiliation: People and Work Outpatient Clinic, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Truus
authors.initials: T
authors.lastname: Hooiveld
authors.affiliation: MOVE Research Institute, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marco J M
authors.initials: MJ
authors.lastname: Hoozemans
authors.affiliation: Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Leendert
authors.initials: L
authors.lastname: Blankevoort
authors.affiliation: Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Matthias U
authors.initials: MU
authors.lastname: Schafroth
authors.affiliation: Department of Orthopaedics, Amphia Hospital, Breda, The Netherlands.
authors.forename: Rutger C I
authors.initials: RC
authors.lastname: van Geenen
authors.affiliation: People and Work Outpatient Clinic, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Monique H W
authors.initials: MH
authors.lastname: Frings-Dresen
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D012189:Retrospective Studies; D062707:Return to Work; D012307:Risk Factors; D012737:Sex Factors; D018582:Sick Leave; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Arthroplasty; Body mass index; Employment; Pain; Physical activity; Prognosis; Replacement