Page 144 - The value of total hip and knee arthroplasties for patients

Chapter 7
seems to be counterintuitive and poses an interpretation challenge according to the authors.They suggest that it may be a result of the FCI simply not being an accurate predictor of returning to work, as it was intended to be a predictor of physical function.
The systematic review by Kuijer et al.3 included only three articles46 investigating the beneficial or restricting factors regarding return to work in patients undergoingTHA orTKA. In only one of the three articles6 was a multivariate analysis performed.The absence of multivariate analyses seriously limits the interpretability of the results, as many factors may have an impact on work status, so adjustment for confounders is indispensible. Overall, the methodological quality of the studies included in this review was moderate to low. The relatively often employed retrospective study designs and use of selfconstructed questions and questionnaires increased the risk of bias. Moreover, potential bias due to patient selection was also relatively frequently identified.This study has a number of limitations. First, we included only studies in English, French, German or Dutch, so that potentially eligible studies in other languages may have been missed. Second, we did not attempt to pool data, as studies were very heterogeneous concerning study designs, patient selection and measurement methods.
In conclusion, this systematic review shows that in general, work status improves after THA and TKA. However, there are fewer studies of TKA than THA and the methodological quality of the available studies is moderate to low.The conduct of large studies in unselected groups of patients, the standardization of measurements of work status in THA and TKA, as well as the conduct of multivariate statistical analyses to adjust for potential confounding in studies to describe determinants of work status postoperatively is recommended.
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