Page 160 - The value of total hip and knee arthroplasties for patients

Chapter 8
those data were only compared with the TKA patients in our study, comparisons are seriously hampered by the observation that Lombardi et al. selected patients between 18 and 60 years of age and excluded patients with extensive medical comorbidities that would limit their activity level.
In the aforementioned systematic review6 and a recent study by Lombardi et al.15, the time of return to work afterTHA andTKA ranged from 1.1 to 10.5 weeks after THA (five studies) and 8.0–12.0 weeks afterTKA (five studies).6 In comparison with these time periods, the mean time to return to work of 12 weeks as observed in the present study appears to be relatively long for THA. As the studies done so far were executed in different countries, it cannot be ruled out that the time of return to work may be dependent on the healthcare system as well as the social security system. In the Netherlands, sick leave from work is fully paid for during the first 2 years. Less favorable clinical outcomes are probably not likely to have played a role in the present study, as improvements of all clinical outcomes were in the same range as in other studies in unselected patients undergoing THA or TKA.20, 30–32 To get more insight into the course of return to work in individual patients, more prospective studies measuring work status at multiple time points during the first year after surgery are needed.
Concerning the characteristics of patients who did and who did not return to work, no statistically significant differences were seen in the present study. On the one side, this could be related to the relatively small proportion of patients who did not return to work but is on the other hand consistent with the literature.A systematic review of the literature on determinants of return to work after THA and TKA found that only the surgical technique and the provision of movement restrictions to patients after surgery were related to return to work afterTHA.16
An interesting finding of the present study which was, to our knowledge, not addressed in the literature was that postoperatively a considerable proportion of the THA and TKA patients worked less hours than before surgery. This loss of productivity does not seem to be counterbalanced by the relatively small numbers of patients who worked more hours than preoperatively and the numbers of patients who did not work preoperatively but were gainfully employed after 1 year.
Our study showed some differences between working THA patients who did and who did not attain the number of hours they worked preoperatively.The number
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