Caring Medical - Where the world comes for ProlotherapyHow fast can I return to work after knee replacement? 15 to 30% of patients do not return to work

Ross Hauser, MD  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
David N. Woznica, MD | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Katherine L. Worsnick, MPAS, PA-C  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
Danielle R. Steilen-Matias, MMS, PA-C | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois

How fast can I return to work after knee replacement? 15 to 30% of patients do not return to work

The question for many facing knee replacement is not IF they can return to work, but WHEN?  The longer the delay the greater out of pocket expense, lost work time, lost salary, especially among the self-employed with physically demanding jobs.

Compared to the amount of research on knee replacement procedures, outcomes, and failure protocols, there is only a small amount of research information focused on giving doctors helpful information to offer knee replacement patients in helping them back to work. In fact, the most recent studies on this subject are focused themselves on the lack of research and the lack of support in helping workers get back to the job. Here is the dilemma according to researchers:

15 to 30% of patients do not return to work after knee replacement

A study by a team of Canadian doctors published in the Annals of Physical and Rehabilitation Medicine made this assessment:

“Total knee arthroplasty (replacement) is an effective intervention for people with osteoarthritis. However, 15 to 30% of patients do not return to work, and studies frequently fail to provide an explanation of what may lead to work disability. . . “(1)

Many patients decided on retirement rather than go back to work after total knee replacement

In a study of 167 patients who were working at the time of their total knee replacement surgery, researchers at the University of Amsterdam wanted to know why 46 patients did not return to work and 121 did. So they started looking for clues.(2)

  • The average age of the 167 patients was 60 at the time of the surgery
  • More than half of these patients had significant weight problems, 58% being obese
  • Physically demanding work:
    • About half the patients: Forty-eight percent performed light work
    • 32 % medium level physical work
    • and 20 % heavy knee-demanding work before total knee replacement surgery.
  • Thirty-one percent of the total knee replacement patients were of the opinion that their work had caused or aggravated their knee symptoms.

Of the 46 that did not return to work:

  • Eight of the patients said they did not return to work because of problems related to the knee replacement.
  • Seven of the patients reported other physical complaints that prevented them from returning to work.
  • The other 31 took early retirement from this work.

The researchers noted something interesting in this group.

Before the surgery, these patients took a lot of days off or “sick leave.” The researchers speculated that knee pain was keeping them from work and that if they had knee replacement sooner they could have returned to work as opposed to “early retirement” or other problems related to their ability to do their job. As we have seen in our clinics, going to knee replacement sooner is not always a viable option, that is why the patient is in our office seeking an alternative to the knee replacement.

How about the 121 who did return to work:

  • 8 returned to work within 1 month
  • 50 between 1 and 3 months
  • 43 within 3–6 months
  • and 20 after 6 months.

Of these patients,

  • 19 reported that they had a less physically demanding job after returning to work,
  • 79 had an equally physically demanding job,
  • and 12 had a more physically demanding job after returning to work.
  • Regarding working hours, 11 patients reported fewer working hours, 96 reported the same number of working hours, and five reported more working hours.

The ability to make a living

The researchers made an interesting statement in their conclusion: “Total knee replacement surgery is being performed on an increasingly younger population of knee osteoarthritis patients for whom participating in work is of critical importance. . . .clinicians should be aware that proxies for participating in work go beyond outcomes like pain or function.”

In other words, patients will go back to work, if they can, regardless of pain and function improvements. We find that for many patients we see, it is the ability to make a living. They have to work.

Returning to work after knee replacement – getting the realistic assessment

Doctors in the United Kingdom examined the return to work experience in patients who had knee replacement surgery. Their study findings published in the British Medical Journal (3) surrounded the asking of 7 questions to patients POST-knee replacement.

  1. Could you start explaining to me what your job involves?
  2. How did your arthritis affect you/your work?
  3. What happened since your operation?
  4. Was the experience after the operation what you were expecting?
  5. What was the involvement of your employer?
  6. Is there anything that has helped you/ or would have helped you to return to work more easily?
  7. What influenced the decision to return to work at that time?

A big problem: post knee replacement information and rehab centers on the retired, longer-term outcomes, such as return to work, were not routinely discussed.

  • The patients in this study found that the advice they received from healthcare professionals focused on the needs of the elderly and retired population.
  • Preoperative education reportedly focused on the inpatient stay and immediate postoperative period, but longer-term outcomes, such as return to work, were not routinely discussed.
  • In summary: Patients found that work-related activities were not discussed and focused on people of a certain age and people who didn’t work.

Patients are concerned that doctors do not factor in the patient’s ability to make a living in surgery decisions

In other words, the question of when can I return to work was not satisfactorily addressed for many. Some patients went to work when they felt like they needed to, some stayed out of work waiting for doctor’s clearance.

  • Doctors top priority in recommending knee replacement: Pain and Function
  • Patients to priority: Function and get back to work

Researchers writing in the Medical Journal of Australia, (4wanted to know what influenced surgeons in determining the order in which patients are scheduled for surgery. In their study, they asked a group of surgeons to assess patient profiles of 80 patients. They also asked a group of non-medical personal (lay people) to assess the patient profiles for their “lay” recommendation.

  • Both groups determined that the patient’s pain was the number one concern.
  • For the surgeons, the other determining factors were physical limitations and other medical factors.
  • The lay people saw it a little differently. While agreeing on the physical limitation part, they were concerned with the patient’s socio-economic situation and the stress a prolonged wait would bring on the patient’s ability to make a living as well as the psychological distress that may bring.

While the surgeons did not consider socio-economic factors in determining priority in patients wait time to surgery, it is clear that for the layperson, the delay to surgery, the surgery, and the recovery time from a total knee replacement are important factors.

There is little in the literature to guide clinicians in advising patients regarding their return to work following a primary total knee replacement

One of the reasons the surgeons may not have prioritized this factor may be found in the literature. Researchers at the Case Western Reserve University School of Medicine. in their study published in the Journal of Joint and Bone Surgery, wrote:

“There is little in the literature to guide clinicians in advising patients regarding their return to work following a primary total knee (replacement). (This study) aimed to identify which factors are important in estimating a patient’s time to return to work. . .how long patients can anticipate being off from work, and the types of jobs to which patients are able to return following primary total knee arthroplasty.”(5)

Information for patients to assess from the study scores were:

  • The average time to return to work after the surgery was nine weeks.
  • Patients who reported a sense of urgency about returning to work were found to return in half the time taken by other employees
  • Other preoperative factors associated with a faster return to work included being female, self-employment, higher mental health scores, higher physical function scores, higher functional comorbidity, and a handicap accessible workplace.
  • A slower return to work was associated with having less pain preoperatively, having a more physically demanding job, and receiving Workers’ Compensation

Information for patients to assess from the study scores were:

  • The average time to return to work after the surgery was nine weeks.
  • Patients who reported a sense of urgency about returning to work were found to return in half the time taken by other employees
  • Other preoperative factors associated with a faster return to work included being female, self-employment, higher mental health scores, higher physical function scores, higher functional comorbidity, and a handicap accessible workplace.
  • A slower return to work was associated with having less pain preoperatively, having a more physically demanding job, and receiving Workers’ Compensation.

If you are on this page because you are seeking alternatives to knee replacement, let’s continue on with these articles on your options:

If you have questions about knee replacement options ask us

Prolotherapy Specialists How fast can I return to work after knee replacement?
Danielle Steilen-Matias, PA-C | Katherine Worsnick, PA-C | Ross Hauser, MD | David Woznica, MD

1 Maillette P, Coutu MF, Gaudreault N. Workers’ perspectives on return to work after total knee arthroplasty. Annals of physical and rehabilitation medicine. 2017 Sep 1;60(5):299-305. [Google Scholar]
2 Kuijer PP, Kievit AJ, Pahlplatz TM, Hooiveld T, Hoozemans MJ, Blankevoort L, Schafroth MU, van Geenen RC, Frings-Dresen MH. Which patients do not return to work after total knee arthroplasty?. Rheumatology international. 2016 Sep 1;36(9):1249-54. [Google Scholar]
3 Bardgett M, Lally J, Malviya A, Deehan D. Return to work after knee replacement: a qualitative study of patient experiences. BMJ Open. 2016 Jan 1;6(2):e007912. [Google Scholar]
4. Curtis AJ, Wolfe R, Russell CO, Elliott BG, Hart JA, McNeil JJ. Determining priority for joint replacement: comparing the views of orthopaedic surgeons and other professionals. Med J Aust. 2011 Dec 5;195(11):699-702. [Google Scholar]
5. 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 Jan 5;93(1):2-10. [Google Scholar]

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