Page 173 - The value of total hip and knee arthroplasties for patients

status after THA was more extensive than for TKA and the methodological quality of the studies was moderate to low, hampering comparisons of rates and speed of return to work among and between studies on THA and TKA. Our clinical study however also found that in total, work productivity after THA and TKA is reduced, a finding warranting more attention in the future.
After all, the findings regarding some loss of productivity may be substantial on the societal level, given the large absolute numbers of patients undergoing total joint arthroplasties in the working age, in part related to the rising pensionable age. It thus warrants further analysis and intervention, such as a more extensive consideration of the type of work and the perceived and expected work limitations before and after surgery. For this purpose, A more intensive cooperation with occupational physicians and physical therapists might be warranted.
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 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. Apart from consensus on definitions, appropriate measurement methods, prospective cohort studies are needed to accurately describe productivity gains and losses over time in this continuum model in THA and TKA.11,12
Overall, the studies in this thesis underline the importance of the process of
recovery inTHA andTKA, although this is evident, considering the extensive surgery 9 with tissue damage, blood loss etc, this has seldom be addressed in these patient
groups. The majority of studies focus on outcome, while the process to have a (un)favourable outcome for a specific patient has less attention. The feasibility
of collecting outcomes relevant for this process of recovery was demonstrated.
Although overall favourable outcomes regarding sustainability of health and return
into society were seen, a number of areas for improvement were identified.
These areas include the better identification of patients with a likely perceived unsuccessful outcome or recovery, including return to work, either preoperatively or as early after surgery as possible. Early identification and subsequent appropriate interventions involving all relevant health care providers, may change the course of recovery of a THA and TKA in a more favourable way for the patient, thus adding value to the patient and not only “adding” an implant into a patient.
General Discussion
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