P. P. F. M. Kuijer

Determinants of return to work 12 months after total hip and knee arthroplasty

Introduction A substantial number of patients undergoing total hip or knee arthroplasty (THA or TKA) do not or only partially return to work. This study aimed to identify differences in determinants of return to work in THA and TKA. Methods We conducted a prospective, observational study of working patients aged <65 years undergoing THA or TKA for osteoarthritis. The primary outcome was full versus partial or no return to work 12 months postoperatively. Factors analysed included preoperative sociodemographic and work characteristics, alongside the Hip Disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), and Oxford Hip and Knee Scores. Results Of 67 THA and 56 TKA patients, 9 (13%) and 10 (19%), respectively, returned partially and 5 (7%) and 6 (11%), respectively, did not return to work 1 year postoperatively. Preoperative factors associated with partial or no return to work in THA patients were self-employment, absence from work and a better HOOS Activities of Daily Living (ADL) subscale score, whereas only work absence was relevant in TKA patients. Type of surgery modified the impact of ADL scores on return to work. Conclusions In both THA and TKA, absence from work affected return to work, whereas self-employment and better preoperative ADL subscale scores were also associated in THA patients. The impact of ADL scores on return to work was modified by type of surgery. These results suggest that strategies aiming to influence modifiable factors should consider THA and TKA separately.

AB0844 Determinants of Returning to Work 12 Months After Total Joint Surgery: Differences Between Total Hip Arthroplasty and Total Knee Arthroplasty

Background The majority of the patients undergoing Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA) returns to work postoperatively, but the absolute number of patients who do not return to work remains substantial. Little is known about factors limiting return to work1, Objectives To identify factors related to return to work after THA and TKA one year postoperatively. Methods This one-year prospective cohort study included patients who were assessed preoperatively and one-year postoperatively, aged 65 years or younger, and who provided information on their work status. Assessments included a questionnaire and/or telephone interview on work status. The outcome of return to work was divided into full return to work vs. partial or no return to work. Potential determinants included the following preoperative characteristics: physical hip/knee-job demands (classified into light, medium or heavy), the amount of working hours a week, self-employement, sick leave duration, granted disability benefits, presence of work adaptions and expectations of returning to work. Logistic regression analyses were employed to determine factors associated partial/no return to work in all patients, controlling for type of surgery (THA or TKA). Results Sixty-seven THA patients (mean age 56 years; SD 6.6, 33 females (49%)) and 56 TKA patients (mean age 56 years; SD 5.7, 31 females (55%)) were included. The mean amount of work hours a week preoperatively was 32 hours (SD 12.5) in THA patients and 31 hours (SD 12.3) in TKA patients. 53/67 THA patients (79%) and 40/56 TKA patients (71%) returned to work fully one-year post-operatively (same mean amount of work hours), whereas 5/67 THA patients (7%) and 7/56 TKA patients (13%) did not return to work at all and 9/67 THA patients (13%) and 9/56 TKA patients (16%) returned to work but less hours than preoperatively (mean decrease of work hours per week -17 hours (SD 11.5, P=0.002) in THA and -16 hours (SD 12.4, P=0.005) in TKA) The THA patients who returned to work partially or not had a lower educational level (P=0.006), were more often self-employed (P=0.009) and were more often absent from work due to hip complaints preoperatively than those fully returning to work (P=0.002). In the TKA group of patients there were no significant differences in characteristics of patients returning to work fully or not. In the multivariable logistic regression analyses, being self-employed (OR 7.4, 95%, CI 1.5-35.8), preoperative absence from work (OR 10.8, 95% CI 2.8-4.8) and working more hours preoperatively (OR 1.03, 95% CI 0.99-1.1) were factors significantly associated with partial/no return to work. Conclusions Self-employment, working more hours and being absent from work preoperatively remained determinants for partial/no return to work after correcting for type of prothesis. These findings underline the need to study return to work after THA and TKA separately. References C.Tilbury, et al., Return to work after total hip and knee arthroplasty: a systematic review. Rheumatology. (Oxford) 53(3), 512 (2014). Acknowledgements This study was funded by the Anna Fonds/NOREF Disclosure of Interest None declared