Page 161 - The value of total hip and knee arthroplasties for patients

Return to work after total hip and knee arthroplasty: results from a clinical study
of hours working preoperatively was one of the factors, which is probably related to the a priori higher chance of losing working hours in patients who work more hours. The higher mean amount of working hours was in part due to some patients filling in more than the common maximum number of working hours in the Netherlands (36–40 h per week), indicating that this group may form a specific subgroup of patients. Larger patient groups are needed to confirm the findings of the present study and study the role of other factors that may have an impact on return to work, such as the characteristics of the surgery and rehabilitation, job characteristics including replacement of the patient’s position or tasks during his or her absence for the operation, or patient factors, such as a choice of the patient to stop working or decrease working hours (age close to retirement so patient decided to retire or work fewer hours). Given the growing number of relatively young and working patients undergoing THA or TKA, the absolute loss of work productivity on the national and international level could be considerable and warrants additional research involving multiple prospective cohorts in different countries on the reason for this loss of productivity at 1 year afterTHA andTKA surgery.
Our study showed that the characteristics of the total groups of patients undergoing
THA and TKA were somewhat different, in particular with respect to BMI and
educational level. It remains to be established to what extent the larger proportion
of patients with a lower educational level in the TKA group (75/120; 63 %) as 8 compared to the THA group (58/122; 48 %) is related to the physical demands
of the job, in particular the knee demands. For that purpose, a study including an extensive assessment of the job characteristics and demands would be needed.
Our study has a number of limitations.The postoperative questionnaires were in a considerable proportion of patients returned incompletely, so that part of the data on postoperative work status needed to be gathered by means of a telephone interview.Moreover,irrespective of whether the data were obtained by questionnaire or telephone interview, the information was gathered partly retrospectively and is therefore prone to recall bias. Studies on return to work should preferably have a prospective design. We also employed 1 year as observation period, which is relatively long as compared to the average period of 12 weeks until return to work. In future research, applying more points for observation during the investigation period is advocated. In such research, information on postoperative complications such as infections, dislocations or deep venous thrombosis should also be recorded,
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