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Study finds most patients capable of returning to work following primary TKA
Patients who state that it is important to them to return within a month do return in half the time.
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“When will I be able to return to work?” is a question most patients ask when they are considering an orthopedic procedure. As surgeons, we base our recommendations on our experience with other patients. Since there are more than 581,000 total knee arthroplasties performed each year in the United States, I have asked Joseph F. Styron, MD, PhD, to share insight he and his colleagues, gained from studying the 162 patients who underwent TKA. I feel it is worthwhile to compare your experience with Styron’s reported findings on some of the return-to-work variables after TKA.
— Douglas W. Jackson, MD
Chief Medical Editor
Douglas W. Jackson, MD: Returning to work following an orthopedic procedure is important to our patients. What methodology did you use to look at this topic in primary total knee replacement (TKR)?
Joseph F. Styron, MD, PhD: We enrolled patients in a prospective cohort study to identify which preoperative patient characteristics could be utilized to predict if and when a patient would return to work following a primary TKR. Patients were enrolled preoperatively within 30 days of their surgery, at which time they completed a questionnaire that assessed a variety of potential factors impacting their ability to work. The questionnaire measured such factors as the physical demands of their job, their knees’ physical functional abilities, scales assessing their global mental and physical well-being, and workplace characteristics, such as whether it was handicap accessible or if they received their health insurance through their employer.
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In addition, patients answered questions measuring their personal, social, financial and health motivations to work. Patients were subsequently asked to complete three follow-up questionnaires until their 6 month routine postoperative check-up appointment. These postoperative questionnaires identified when patients returned to work in either a part-time or full-time capacity.
Jackson: What conclusions from your work can be used by clinicians caring for these patients?
Styron: Our study demonstrates that the vast majority of patients are capable of returning to work following a primary TKR, even to physically demanding jobs. Patients can expect to return to work on average 8.9 weeks after their surgery, although certain patients are able to return at considerably faster rates than their peers.
Among the most important factors to consider when advising patients preoperatively concerning their expectations for returning to work is the importance to the individual that he or she return to work quickly. These highly motivated patients who state that it is very important to them to return within a month do return in half the time as their peers.
Other factors to keep in mind when advising patients include that women return faster than men and patients with greater physical functional abilities and greater pain preoperatively are more likely to return to work faster. Also, patients whose workplaces are handicap accessible and whose jobs are less physically demanding likewise return at slightly faster rates. Many patients are able to work with their employers, however, to alter their work demands temporarily to facilitate a speedier return while the patient is rehabilitating.
Jackson: While your numbers were small, the workers’ compensation patients was a challenge in returning to work. What insights can you offer for this subgroup of patients?
Styron: It is very difficult to reach any broad conclusions regarding workers’ compensation patients from our study as we only had two of these patients. There appears to be potential disincentives for workers’ compensation patients to return to work quickly — distinct from the several types of motivation we measured. These patients may require setting less ambitious goals for returning to work than their peers.
Jackson: What were the most predictive factors to look for in assessing and advising a patient?
Styron: Several patient and workplace characteristics are factors in determining the rate at which patients will return to work. The most important factor in all of our models predicting return to work on either a part-time or full-time basis was how important a rapid return to work was to the individual patient. Along those lines, self-employed patients return to work part-time faster than regular employees, but are not any faster at returning to work full-time. Other significant factors predicting a faster return to work in order of decreasing magnitude of effect include being female, having a handicap accessible workplace, a higher preoperative functional level, more preoperative pain and having a less physically demanding job.
Reference:
- Styron JF, Barsoum WK, Smyth KA, Singer ME. Preoperative predictors of returning to work following primary total knee arthroplasty. J Bone Joint Surg Am. 2011;93(1):2-10.
- Joseph F. Styron, MD, PhD, can be reached at the Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106-4945; email: jxs178@case.edu.
- Disclosure: Styron has no relevant financial disclosures.