Return to Work Within 104 Weeks in Working-Age Patients Following Total Hip Arthroplasty

Background Total hip arthroplasty (THA) is increasingly performed in working-age adults, making return-to-work (RTW) an important outcome. In the Netherlands, RTW is particularly relevant due to the legal obligation for employers to cover up to two-years of sick leave. While short-term RTW outcomes after THA have been described, evidence on long-term RTW and its determinants remains limited. This study evaluated RTW up to two-years after THA and explored clinical, occupational, and sociodemographic factors associated with RTW. Methods This single-center cohort study included patients aged 18-65 years who underwent primary THA between January 2016 and February 2018 at Zuyderland Medical Center (Sittard-Geleen, the Netherlands). Eligible patients were invited to complete a questionnaire on employment status, RTW timing, occupational characteristics, expectations, and perceived facilitators and barriers, alongside patient-reported outcome measures (PROMs: Oxford Hip Score and EuroQol Five Dimensions (EQ-5D)). Descriptive analyses were performed, and multivariable logistic regression was used to identify predictors of RTW. Time to RTW was analyzed using reversed Kaplan-Meier curves. Results Of 381 eligible patients, 182 responded (53.8%), and 145 completed all questionnaires (mean age 58.7 ± 5.6 years; 51% female). Preoperatively, 66% were employed and 6% self-employed. Full RTW was achieved by 77% of employed and 78% of self-employed patients, with a mean time to RTW of 7.4 ± 4.4 weeks. Most patients RTW within 12-weeks, with additional RTW occurring up to 52-weeks postoperatively. Full RTW was most common in administrative, managerial, and care-related occupations, whereas physically demanding jobs more often required modified duties or reduced hours. Social support at work and job satisfaction were the most frequently reported facilitators of RTW, while physical complaints and high physical workload were the main barriers. In multivariable analysis (n = 106), female sex was the only independent predictor of non-RTW (odds ratio (OR) 3.74, 95% confidence interval (CI) 1.29-10.84, p = 0.015). Other clinical and occupational factors were not significantly associated with RTW. Conclusion The majority of working-age patients returned to work within 12-weeks after THA and remained employed for two years. Female sex was independently associated with a lower likelihood of RTW. Enhanced occupational guidance, workplace adjustments, and targeted support may further optimize sustainable work reintegration after THA.