Page 130 - The value of total hip and knee arthroplasties for patients

Chapter 7
Measures of work status
Table 2 describes the measures of work status employed in the various studies as well as the related outcomes.There was great variability concerning the definition of work status before and after surgery among the studies, ranging from employed or working (yes/no)6, 11-14, 18, 21-24 and type of profession (white collar, intermediate, or blue collar)10 to mixed classifications, including household/light work/moderate work/heavy work/sick leave/retired11, 12, 16, 21 and physical/mental/service trades/ housework16, 17 and the experience of working problems because of hip and knee complaints.11, 11, 14, 15, 17, 20-22 The work status of the patients prior to surgery was described in 15 studies (10 studies on THA5, 10-12, 14-18, 20, 3 studies on TKA22-24 and 1 study on THA and TKA6).
The work status of patients after surgery, irrespective of its definition, was described in 15 studies (11 studies on THA5, 10-17, 20, 21, 3 studies on TKA22-24 and 1 study on THA and TKA6). In the studies describing return to work, the proportions of patients returning to work ranged from 25 to 95% at 1-12 months afterTHA (n=7 studies) and from 71 to 83% at 3-6 months after TKA (n=2 studies).
The time to return to work in patients who were working preoperatively was described in a limited number of studies. Return to work after THA (described in five studies) ranged from 1.1 to 10.5 weeks5, 11, 18-20, 25 and after TKA (described in four studies) ranged from 8.0 to 12.0 weeks.22-25 The other nine studies did not measure the time to return to work in weeks, but measured only working status at different time points.
Determinants of work status
Table 3 shows the results of 19 studies examining determinants of work status after THA and/or TKA. Less than half of the studies employed multivariate analyses. Fourteen papers reported on determinants of return to work after surgery inTHA.4- 6, 10-17, 19-21 In papers using multivariate analyses6, 11, 14, 17 it was found that female gender, older age, pain in joints other than the hips, failure of the procedure, physical work, unskilled work and being a farmer were associated with worse work outcomes.11, 14, 17 In addition, younger age, more education, working 1 month preoperatively, mental work, primary coxarthrosis and having a better postoperative walking ability were associated with better work outcomes.11, 14, 17 The type of prosthesis and surgical procedure11 (dividing patients into five groups based on the bearing surface and
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