¹Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
²Vrije Universiteit Amsterdam, Department of Human Movement Sciences, Amsterdam, Netherlands
³Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery and Sports Medicine, Amsterdam, Netherlands
⁴Amphia Hospital, Breda, Netherlands
⁵Xpert Clinics Orthopedie Amsterdam Laarderhoogtweg, Amsterdam, Netherlands
⁶Tergooi MC locatie Hilversum, Hilversum, Netherlands
⁷Anna Hospital, Geldrop, Netherlands
⁸OLVG Location West, Amsterdam, Netherlands

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Introduction: After total knee arthroplasty (TKA), a minority of working patients are dissatisfied and experience a late or no return to work (RTW). Patients who have a lot of difficulty with performing work-related knee-straining activities might have more difficulty with RTW. This study aimed to identify whether a pre-defined grouping based on self-reported ability to perform work-related knee-straining activities at three months post-TKA was associated with the ability to perform work-related knee-straining activities at six and 12 months and RTW at three, six, and 12 months post-TKA.

Methods: A 12-month multicenter prospective cohort study was performed among working TKA patients intending to RTW. The work, osteoarthritis, or joint replacement questionnaire (WORQ) score (range 0 to 100) was used to assess patients’ ability to perform thirteen work-related knee-straining activities. Patients were grouped based on their WORQ-score at three months post-TKA into 1. Early (WORQ ≥ 71), 2. Intermediate (WORQ 51 to 70), and 3. Late (WORQ ≤ 50) recovery of work-related activities. Analyses included Spearman’s correlation tests, and Kaplan-Meier survival analyses.

Results: The median age of the cohort (n = 182) was 59 years [IQR [interquartile range] 55 to 62], and 52% were women. The early- (n = 54) and intermediate-recovery groups (n = 68) clinically improved their ability to perform work-related knee-straining activities at three and 12 months, respectively, while the late-recovery group (n = 60) did not do so until 12 months (rs = 0.6, 0.27, and 0.25, respectively). The early-recovery group returned to work earlier (median 62 [IQR 41 to 90] days) compared to the intermediate- (75 [46 to 115] days) and late-recovery groups (84 [58 to 116] days) and resumed 100 percent of their working hours at six months versus 12 months in the intermediate- and late-recovery groups (rs = 0.37, 0.33, 0.1 at three, six, and 12 months, respectively).

Discussion: At three months post-TKA, the WORQ can be used to distinguish early-, intermediate-, and late-recovery groups, which are associated with the ability to perform work-related knee-straining activities at six and 12 months post-TKA and RTW at three and six months. A suggestion for further research would be to determine whether late-recovery patients could be detected earlier than at three months postoperative, say at six weeks after surgery, bringing the opportunity to start interventions earlier. The finding that difficulty with work-related knee activities can persist for up to one year or longer after TKA in patients with intermediate and late recovery may increase awareness among patients, clinicians, and occupational health professionals that timely workplace accommodations and referrals to occupational health professionals for musculoskeletal disorders may be necessary.

Conclusion: The WORQ score at three months after TKA can help clinicians, physical therapists and occupational health professionals monitor patients at higher risk for delayed return to work in a timely and effective manner.