Page 149 - The value of total hip and knee arthroplasties for patients

Return to work after total hip and knee arthroplasty: results from a clinical study
Introduction
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are very effective procedures to improve pain and functioning in patients with hip and knee osteoarthritis.1, 2 The numbers of patients undergoing THA and TKA surgery are substantial, the rate per 100.000 persons varying between 70 and 112 in northern European countries and the USA.3–5 Although the rates reported in the literature vary, there are many studies showing that a considerable proportion of these patients (15–45 %6, 7, 9) is of working age and/or <65 years at the time of surgery.
With respect to return to work after THA or TKA, the number of studies is limited. A recent systematic review by Tilbury et al.6, including studies from 1986 to 2013, found that the majority of patients who are employed beforeTHA andTKA returned to work postoperatively. Only few of the studies included in this review reported the mean time to return to work, with the reported durations ranging from 1.1 to 10.5 weeks after THA1, 7–11 and from 8.0 to 12.0 weeks after TKA.2, 11, 12 As the study designs as well as the assessment methods varied largely among the studies, firm conclusions regarding the speed of return to work cannot be drawn.6
After this systematic review was completed, a study by Sankar et al.13 was published, 8 evaluating the return to work among 360THA andTKA patients who were working preoperatively or on a shor t-term disability pension. It was found that 87 % of THA
and 85 % ofTKA patients had returned to work 1 year after surgery.This study did
not report the mean time to return to work. Kievit et al.14 examined the impact of TKA on patients’ reintegration into the workplace, showing that 117 of 173 working patients (68 %) had returned to work 3.8 (1.3 SD) years after surgery. Lombardi et al.15 found in a group of 494 patients who were employed before TKA that 98 % returned to work after on average 8.9 weeks (SD 9.1).
Concerning beneficial and limiting factors affecting return to work after surgery, Kuijer et al.16 conducted a systematic review including studies published between 1998 and 2008. All of the three studies included in that review concerned THA, with the results suggesting that using a two-incision approach has a beneficial effect on return to work, whereas the provision of movement restrictions had a negative effect, and patient discharge guidelines had no effect on the time to return to work.
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