Which patients do not return to work after total knee arthroplasty? Paul Kuijer, Arthur Kievit, Thijs Pahlplatz, Truus Hooiveld, Marco Hoozemans, Leendert Blankevoort, Matthias Schafroth, Rutger van Geenen, Monique Frings-Dresen Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands Orthopaedic Research Center Amsterdam, Academic Medical Center MOVE Research Institute, Vrije Universiteit Amsterdam Department of Orthopaedics, Amphia Hospital, Breda 1

Academic Medical Center Amsterdam, the Netherlands Academic Medical Center Focus of the department: Prevention of occupational diseases & Optimizing work functioning

Powerpoint presentaties NCvB Quiz time How many workers do NOT return to work after total knee arthroplasty surgery? a) none, every worker starts again b) 6 out of 100 c) 15 out of 100 d) >25 out of 100

Powerpoint presentaties NCvB Answer = D: >25% (30%) Author Number (%) patients RTW Husted et al 46 (56) Styron et al 122 (75) Foote et al. 23 (85) Walton et al. 17 (81) Jorn et al. 52 (59) Nielsen et al. 40 (78) Weingarten et al 41 (81) Kievit et al. 117 (68) Total 458 (70) Returns to Work: 70% range 56%-81% Kievit et al.Total Knee Arthroplasty and the Unforeseen Impact on Return to Work: A Cross-Sectional Multicenter Survey. J ARTHROPLASTY 2014;29 (6):1163-1168

250% KP increase until 2030 in the Netherlands 2016: 50% primary TKA < 65 years in USA Kurtz et al. 2009 CORR …stay at work? Incidence per 10,000 inhabitants Age class Otten et al. Trends in the number of knee and hip arthroplasties: considerably more knee and hip prostheses due to osteoarthritis in 2030. Ned Tijdschr Geneeskd 154:A1534

What do we know? ‘Little is known about effective interventions (treatments, work changes and policies) to improve vocational participation …. or how type of work affects long-term clinical outcomes (e.g. pain, function and the need for revision surgery) in patients with TKRs. Palmer (British Medical Bulletin 2012)

Only two multivariate studies on RTW among 332 TKA patients… Physically demanding work Sex Sankar A et al. Return to work and workplace activity limitations following total hip or knee replacement. Osteoarthritis Cartilage. 2013;21:1485-93. Styron JF et al. Preoperative predictors of returning to work following primary total knee arthroplasty. J Bone Joint Surg Am. 2011;93: 2-10.

What patients’ characteristics are associated with no RTW? Research question What patients’ characteristics are associated with no RTW? Kuijer PP, Kievit AJ, et al. Which patients do not return to work after total knee arthroplasty? Rheumatology International Accepted June 15 2016 DOI: 10.1007/s00296-016-3512-5

Methods Multicentre retrospective cohort study Working patients having undergone a primary TKA during 2005-2010, follow-up at least 2 years No RTW: “I didn’t get back to work” after TKA surgery Patient files: pre-op: sex, age at surgery, Body Mass Index, and comorbidity Questionnaire: post-op: Preoperative sick leave, patient-reported work-relatedness of knee symptoms, Type of job, Knee injury and Osteoarthritis Outcome Score (KOOS) including Pain, Other Symptoms, Activities of Daily Living (ADL), Functioning in Sports and Recreation (Sport/Rec), and Knee-related Quality of Life Backward stepwise regression analysis (OR, 90%CI)

Participants

What kind of patients? All n=167 RTW n=121 No RTW n=46   All n=167 RTW n=121 No RTW n=46 Sex, males (n, %) 82 (49) 63 (52) 19 (41) Age at surgery, year (mean, SD) 60 (8) 59 62 Body mass index ≥30 kg/m2 (n, %) 68 (42) 47 (40) 21 (46) Preoperative sick-leave (n, %) 0-2 wks 108 (66) 95 (80) 13 (29)  2-4 wks 6 (4) 4 (3) 2  1-3 mnths 14 10 (9)  >3 mnths 37 (22) 11 26 (58) Knee-demand work (n, %) Light 66 (48) 53 (53) (35)  Medium 44 (32) 25 (25) (51)  Heavy 27 (20) 22 5 (14) Work-relatedness complaint, Yes (n, %) 52 (31) 29 (24) 23 (50) KOOS Pain 0-100 (mean, SD) 80 83 (21) 74 (26) KOOS ADL 0-100 (mean, SD) 78 (23) 81 69 (28)

Not: pain, other symptoms, ADL or Sport/Leisure time, … 5 predictors no RTW No RTW (n=46) Reference (n=121) OR 90%CI Preoperative sick-leave duration >2 weeks 0-2 wks 12.4 4.9 31.2 Work-relatedness of knee symptoms (Yes) No 5.2 2.0 14.0 Medium knee-demanding job Light 3.3 1.2 8.8 Female Male 3.2 1.3 8.2 Body Mass Index ≥30.0 <30 2.8 1.1 7.1 Not: pain, other symptoms, ADL or Sport/Leisure time, … Kuijer PP, Kievit AJ, et al. Which patients do not return to work after total knee arthroplasty? Rheumatology International Accepted June 15 2016 DOI: 10.1007/s00296-016-3512-5

Improve work-directed care Conclusion Especially obese female workers, with a preoperative sick-leave duration > 2 weeks, who perform knee-demanding work and indicate that their knee symptoms are work-related have a high chance for no RTW after TKA. Improve work-directed care Active referral of these patients by orthopaedic surgeon to occupational physician

Thank you for your attention! p.p.kuijer@amc.nl