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Which patients do not return to work after total knee arthroplasty?
P Paul F M Kuijer1, Arthur J Kievit2, Thijs M J Pahlplatz2
1People 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.
Rheumatology International
|June 26, 2016
Summary
Many patients do not return to work (RTW) after total knee arthroplasty (TKA). Preoperative factors like longer sick leave, obesity, female sex, and physically demanding jobs increase the risk of no RTW after TKA.
Area of Science:
- Orthopedic Surgery
- Occupational Health
- Rehabilitation Medicine
Background:
- Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis, yet a significant number of working patients do not return to work (RTW).
- Limited evidence exists to guide clinicians on identifying patients at high risk for not returning to work post-TKA.
- Understanding preoperative predictors of no RTW is crucial for targeted interventions.
Purpose of the Study:
- To identify preoperative patient characteristics associated with no RTW after primary TKA.
- To provide clinicians with data to better counsel and manage patients at risk for not returning to work.
Main Methods:
- A multicenter retrospective cohort study involving 167 patients who underwent primary TKA between 2005-2010.
- Preoperative factors assessed included age, sex, BMI, comorbidity, sick-leave duration, work-relatedness of symptoms, and job demands.
- Backward stepwise logistic regression was used to predict no RTW, with Knee injury and Osteoarthritis Outcome Scores (KOOS) also evaluated.
Main Results:
- A preoperative sick-leave duration exceeding 2 weeks was the strongest predictor of no RTW (OR 12.5).
- Other significant predictors included female sex (OR 3.2), BMI ≥ 30 (OR 2.8), patient-reported work-relatedness of knee symptoms (OR 5.3), and physically knee-demanding jobs (OR 3.3).
- Age and postoperative KOOS were not associated with no RTW.
Conclusions:
- Obese female workers with prolonged preoperative sick leave, knee-demanding jobs, and work-related symptoms face a high likelihood of not returning to work after TKA.
- These findings highlight the necessity for early referral to work-directed care for at-risk patients.
- Proactive management strategies are essential to improve RTW rates following TKA.
