Page 143 - The value of total hip and knee arthroplasties for patients

Return to work after total hip and knee arthroplasty: a systematic review
However, one of the studies included in this review provided an extensive overview of the literature on THA in its discussion11, concluding that all of the four available studies12, 15, 16, 26 were limited by one or more of the following flaws: (i) small patients cohorts (<120 patients in total), (ii) the average age in the study was >60 years, (iii) the study included low-demand patients, (iv) the study was reported in the literature >20 years ago and (v) the study was not designed to specifically look at returning to work. In contrast with that review, nowadays more studies, describing larger groups of patients are available.
However, we saw a relatively large variation with respect to the study designs, patient
selection and, in particular, the measurement of work status, seriously hampering
the comparisons among the studies in this review. International consensus on a
minimum set of variables related to work status would enable national and
international comparisons of studies and greatly increase knowledge in the field of
the impact ofTHA andTKA on work status.It is questionable whether retrospective
studies are suitable to measure work status before and after THA or TKA. Work
status is a complex entity, with work disability including decreased work productivity
while present at work, temporary absence or sick leave or not working at all due 7 to health problems, with or without a full or partial disability pension. In addition, unemployment, (early) retirement and/or stopping work voluntarily, whether or
not related to health status, may also occur. Apar t from appropriate measurement methods, prospective cohort studies are needed to accurately describe productivity gains and losses over time in this continuum model.9
Regarding the analyses of determinants of return to work after TKA and THA, in 11 of the 16 studies including such analyses, only univariate methods were used4, 5, 10, 12, 13, 15, 16, 19, 22, whereas 5 studies employed multivariate techniques.6, 11, 14, 17, 24 Overall, in the studies using multivariate analyses, characteristics of the patient (sex, age, educational level), his or her health status (the involvement of joints other than the operated hip or knee, mental and physical health, failure of the procedure), preoperative work status (type of employment,working until surgery,characteristics of the workplace, reporting problems with activities at work) were found to be associated with work status after surgery.
With respect to gender, the results were contradictory. In the study by Styron et al.24, a higher FCI was associated with a faster return to work. This observation
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