Return to work after total hip and knee arthroplasty: a systematic review

Objectives. The aim of this study was to describe work status and time to return to work in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) and to determine which factors are associated with work status. 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). 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 1-12 months after THA and from 71 to 83% at 3-6 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.