Work outcomes after hip and knee replacement.

Investigating the mid-to-long term effects of knee and hip arthroplasty on return to work and patients’ working lives

Osteoarthritis causes significant problems in the working age population. Hip replacement and knee replacement are successful operations increasingly offered at younger ages. Moreover, people are being encouraged to work to older ages so that these operations are increasingly likely to occur in people who need to return to work (RTW) post-operatively.

Currently, there is no evidence-based guidance for when and how people can expect to return to different types of work after surgery. Furthermore, little is known about the impact of mid- to long-term effect of physically-demanding occupational and leisure activities on the replaced joint.

Aims

The main aims of this study are to:

  • Review existing literature to evaluate which factors impact time taken to return to work (RTW) after total hip replacement (THR) and total knee replacement (TKR).

  • Assess time to RTW and associated factors in a group of people who were awaiting to undergo THR and TKR and expecting to resume to work.

  • Evaluate people’s experiences since the time awaiting to have surgery until return to work postoperatively and what advice they receive during that journey

  • Systematically review whether there is evidence on the role of occupational and leisure activities exposure and risk of post-operative joint failure

  • Evaluate mid-term outcomes of lower limb arthroplasty in retrospective cohorts of THR and TKR recipients. More specifically, to explore if exposure to physically demanding activities after arthroplasty is likely to affect the mid to long-term risk of joint failure, physical function, and workability

What did this research involve?

This research involved two PhD projects and included:

  • A prospective cohort study

  • Two systematic reviews

  • A qualitative study and

  • Analysis of registry data from the COASt study and the Geneva Arthroplasty Registry

What did the study find?


Return to work (RTW) after arthroplasty

The literature review on factors to RTW found a marked heterogeneity across the literature in terms of how RTW was measured, ranging from mean or median times, or proportions of patients returning by a fixed time point.  There was some evidence to suggest that earlier RTW was associated with: younger age at time of surgery; possibly male gender; higher levels of educational attainment; some surgical techniques; unrestricted post-operative rehabilitation and not being off sick pre-operatively.

Analysis from a prospective cohort of people waiting for THR /TKR surgery showed that he median time to RTW was 62 days (range 10-165) after hip arthroplasty; and 55.5 days (range 19-174) after knee arthroplasty. Earlier time to RTW was associated with: younger age; better score for EQ-5D usual activities pre-operatively; not needing to stand/walk at work for > 2 hours/day; and expecting to be able to RTW within 7 weeks. There was no indication of harm after returning to work early, either within 30 days or 49 days of surgery.

Furthermore, people’s views about when to RTW after surgery included the following key themes: i) trust that the replaced joint has healed; ii) self-efficacy to achieve a successful RTW; iii) support from the healthcare team; iv) and also from the workplace to which the workers need to return

 

Mid-term outcomes after lower-limb arthroplasty

The literature review on the risk of lower limb arthroplasty and exposure to work and leisure activity showed that there is insufficient evidence about risk of THR /TKR revision surgery and exposure to leisure-time activities. There was weak evidence to suggest a small increased risk of THR revision surgery in workers exposed to physically demanding occupational activities post-operatively but insufficient evidence for a conclusion after knee arthroplasty.

Given the scarcity of literature on post-replacement outcome we retrospectively followed a cohort of THR, TKR and unicompartmental knee replacement recipients.  We found that at least 5 years post-operatively most of the people who were working at the time of the operation resumed to work, and some people unable to work pre-operatively returned to work after surgery. However, people with a hip implant may not RTW when the job is more physically-demanding. Furthermore, it may be challenging to sustain employment when the job entails physically demanding activities: standing prolonged hours and kneeling or squatting (for THR), climbing >30 flights of stairs (for TKR/UKR) and lifting/carrying weight (for hip and knee replacements). Despite this, there was a high prevalence of excellent or good function at follow-up

Publications

Papers

Conferences

  • Virtual Physiotherapy Conference (November 2021, online). Returning to and staying in work after knee replacement

  • Epidemiology in Occupational Health (EPICOH) conference (October 2021, online). Rates of return to work and work ability following knee replacement

  • Epidemiology in Occupational Health (EPICOH) conference (October 2021, on-line). Return to work and job loss following hip replacement: findings from two longitudinal cohorts.

  • British Society for Rheumatology Conference (April 2021; on-line). Returning to, and staying in, work after total hip arthroplasty

  • British Society for Rheumatology Special Interest Group on musculoskeletal health and work, (May 2021, on-line). Return to work after lower limb arthroplasty

  • Health, Work & Wellbeing, March 2020 (NEC, Birmingham). Working after lower limb arthroplasty

Study team

Chief investigator
Professor Karen Walker-Bone (Monash University)


Co-investigators
Dr E. Clare Harris (University of Southampton)
Dr Cathy Linaker (University of Southampton)
Dr Georgia Ntani (University of Southampton)
Ms Stefania D’Angelo (University of Southampton)
Dr Elena Zaballa (University of Southampton)
Dr Lisa Savage-Shipway (University of Southampton)

Centre institutions

Further information

For any queries related to this work, please contact kwb@mrc.soton.ac.uk