Most TKR Patients Return to Life, Work Following Surgery

Ninety-eight percent of total knee replacement (TKR) patients who were working before surgery returned to work after surgery, and of those patients, 89% returned to their previous position, according to research conducted by Adolph V. Lombardi Jr, MD, Orthopedic Surgeon, New Albany, Ohio. Another related study by Anne Lübbeke-Wolff, MD, DSc, Orthopaedic Surgeon, Geneva, Switzerland, and colleagues, highlights the life-restoring outcomes of total hip replacement (THR).

TKR, or arthroplasty, among the most widely performed procedures in the world, is known to successfully relieve pain and restore function in patients with advanced knee arthritis. In their study, Lombardi and colleagues conducted a multicenter study including patients of working age (18-60 years) who underwent a total knee arthroplasty 1 to 3 years previously; an independent third party survey center provided questionnaires and interviewed more than 660 TKR patients from 5 major medical centers.

Definitions from the United States Department of Labor's Dictionary of Occupational Titles were used to categorize the patients' physical job demands as sedentary, light, medium, heavy, or very heavy. Complete data was collected on 661 TKR patients, with an average age of 54.2; 61.3% were women.

The investigators found that 493 out of 661 of the patients (74.6%) were employed during the 3 months prior to their surgery, and 449 out of 493 patients returned to work after surgery (91.1%). In addition, 93.3% of the patients successfully returned to the job they had prior to surgery. Approximately 13% of the patients had sedentary jobs; 11% light jobs; 24% medium; 23% heavy; and, 29% very heavy. According to work type the return to work rate was 92.3% among sedentary employees; 79.2% among those in jobs deemed light; 89.0% in medium jobs; 87.8% in heavy jobs; and 78.2% in very heavy jobs. Men were significantly more likely to return to work, compared with women (82.3% vs 73.7%, respectively).

"When pain and suffering from end-stage degenerative joint disease of the knee compromises a patient's ability to maintain gainful employment, TKR is successful in keeping the patient in the work force," said lead study author Lombardi. "Returning patients back to work not only gives the patient a sense of fulfillment, but also is economically beneficial to our society."

In the second study, Lübbeke-Wolff and colleagues assessed THR patients treated at a large Swiss hospital between 2000 and 2012 evaluated by a physician, and through self-reported assessments, at 5- and 10-years postoperatively on their level of physical activity. Separate analysis was performed according to sex, age, body mass index, and American Society of Anesthesiologists (ASA) physical status before and after surgery.

Lifestyle was assessed for nearly 2,916 THR patients prior to surgery, and postoperatively for 1,565 patients. The mean age at surgery was 68.4 years, and 56% of patients were women. Preoperatively, 39% of patients reported an active lifestyle, compared with 55% at 5 years postoperatively. Medical comorbidities, BMI, primary or secondary osteoarthritis diagnosis prior to surgery, and the patient's preoperative activity level, substantially influenced physical activity five years post surgery. In the last decade, the proportion of patients with an active lifestyle before and after THR has increased by 10%.

"This is the first study with a long-term follow-up (up to 10 years) to evaluate physical activity levels after THR," said lead study author Lübbeke-Wolff. "Surgery substantially and durably improved physical activity levels in men and women of all age categories, but the level remained somewhat lower than just before the onset of osteoarthritis symptoms.

"In most instances, patients who had previously participated in activities such as bicycling, bowling, golf, mountain hiking or swimming, and who wished to continue them after surgery, were able to return to these activities," she added. "Patients presenting for THR today are more active than those undergoing surgery a decade ago for similar preoperative pain level. Patients should be given a realistic assessment of what to expect following THR in terms of activity."