RHEUMATOLOGY
Rheumatology 2014;53:512525 doi:10.1093/rheumatology/ket389 Advance Access publication 23 November 2013
Original article Return to work after total hip and knee arthroplasty: a systematic review Claire Tilbury1, Wouter Schaasberg1, Jose´ W. M. Plevier2, Marta Fiocco3, Rob G. H. H. Nelissen1 and Theodora P. M. Vliet Vlieland1 Abstract
Methods. A systematic search strategy in various databases through April 2013 was performed. All clinical studies concerning patients undergoing THA or TKA providing quantitative information on work status before and after surgery were eligible for inclusion. Extracted were study characteristics, data on work status and determinants of return to work. The methodological quality was evaluated in three quality aspects (selection bias, information bias and statistical analysis bias).
CLINICAL SCIENCE
Results. Nineteen studies published between 1986 and 2013 were selected (4 on THA, 14 on TKA and 1 on THA and TKA). These studies included 3872 patients with THA and 649 patients with TKA. The proportions of patients returning to work ranged from 25 to 95% at 112 months after THA and from 71 to 83% at 36 months after TKA. The average time to return to work varied from 1.1 to 13.9 weeks after THA and from 8.0 to 12.0 weeks after TKA. Factors related to work status after THA and TKA included sociodemographic, health and job characteristics. Overall, the methodological quality of the studies was moderate to low. Conclusion. The majority of patients who are employed before THA and TKA return to work postoperatively. Comparisons of work status and the rate and speed of return to work between studies in THA and TKA are hampered by large variations in patient selection and measurement methods, underpinning the need for more standardization. Key words: arthroplasty, replacement, knee, hip, work, employment, prostheses and implants, total knee, total hip, sick leave.
Introduction In North America and Europe OA of the hip or knee is one of the most prevalent chronic diseases [1] and the most common reason for total joint replacement. By 2009, the number of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) increased to 1.6 and 1.2 per 1000 per year, respectively, in Western countries [2]. These numbers are expected to further increase in the 1
Leiden University Medical Center, Department of Orthopaedics, Walaeus Library and 3Department of Medical Statistics, Leiden, The Netherlands. 2
Submitted 3 July 2013; revised version accepted 8 October 2013. Correspondence to: Claire Tilbury, Leiden University Medical Center, Department of Orthopaedics J11, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail:
[email protected] coming years due to the ageing society and the growing prevalence of obesity [2]. Currently a substantial proportion of these patients (1545%) [58] is working (age 70, n = 4 Mean age 56 (range 4175): 65, n = 26 Mean age 58.3 years (range 1488)
48 months (range 15168)
THA: Baseline period: 39% males Feedback intervention period: 39% males
90150 days
67 weeks
4.2 years
166 (30.8)
80% males
2 years
Median follow-up time 5 years (range 211)
139 (35.9)
76 (64.4)
4 years
Duration of follow-up after surgery
78 (43.8)
Gender, n (%), male
THA: Baseline period: mean age 67.0 (S.D. 11.5) Feedback intervention period: mean age 64.9 (S.D. 12.8)
Mean age: 63.8 5 (0.9%) 2534 13 (2.4%) 3544 57 (10.5%) 4554 174 (32.%) 5564 244 (45.3%) 6574 46 (8.5%) 7584 Mean 46.9 (S.D. 0.3) (range 1864)
All patients who were admitted for Median 67 (range 2189); treatment of hip disease by THA 99 patients