PATIENTS’ EXPECTATIONS ARE PROGNOSTIC FOR DISSATISFACTION WITH PERFORMING WORK-RELATED KNEE-STRAINING ACTIVITIES AFTER TOTAL KNEE ARTHROPLASTY. A MULTICENTER COHORT STUDY

Y. van Zaanen¹, T. Siertsema¹, T.M. Pahlplatz², R.C. van Geenen³, A.J. Kievit², M.J. Hoozemans⁴, L. Blankevoort², M.U. Schafroth², D. Haverkamp⁵, T.M. Vervest⁶, D.H. Das⁷, V.A. Scholtes⁸, P.P.F. Kuijer¹

¹Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands, ²Amsterdam UMC, University of Amsterdam, Orthopaedic Research Center Amsterdam, Amsterdam, Netherlands, ³Amphia Hospital, Department of Orthopaedics, Breda, Netherlands, ⁴Vrije Universiteit Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam, Netherlands, ⁵Xpert Orthopaedics, Location Amsterdam, Amsterdam, Netherlands, ⁶Tergooi Hospital, Department of Orthopaedic Surgery, Hilversum, Netherlands, ⁷St. Anna Hospital, Department and Research Center of Orthopaedic Surgery, Geldrop, Netherlands, ⁸OLVG+, Joint Research Orthopedic Surgery, Amsterdam, Netherlands

Background: Two in ten patients are dissatisfied after total knee arthroplasty (TKA) and unmet expectations appear prognostic. TKA is increasingly performed in high demanding working patients, who have high expectations. No data are available whether preoperative expectations about performing knee-straining activities at work are prognostic for being dissatisfied. Physiotherapists engaged in preoperative osteoarthritis care and postoperative occupational rehabilitation for working TKA patients may benefit from knowledge of prognostic factors for patients to become dissatisfied. These prognostic factors could potentially be treatment goals for the physiotherapist and help reduce the risk of a patient being dissatisfied with performing work-related knee-straining activities after TKA.

Purpose: Therefore we wanted to know 1. how many patients were dissatisfied regarding performing work-related knee-straining activities at six months after TKA, and 2. whether preoperative expectations regarding performing work-related knee-straining activities were associated with being dissatisfied six months after TKA?

Methods: A multicenter prospective cohort study was performed among working TKA patients in the Netherlands. Expectations and outcome regarding satisfaction with performing work-related knee-straining activities six months postoperative were measured using the Work Osteoarthritis or joint-Replacement Questionnaire (WORQ). The WORQ assesses the ability to perform 13 work-related activities at 6 months after surgery, like kneeling, working with hands below knee height and lifting. To evaluate whether these expectations were prognostic for being dissatisfied stepwise logistic regression analyses were performed taken into account other factors like age, pain, BMI and comorbidities.

Results: Of the participating 175 working patients (53% female, median age 59 years) thirty-three patients (19%) were dissatisfied at six months after TKA. Patients who expected to be dissatisfied preoperative had a 5.1 times higher odds (95% CI 1.7-15.5) for being dissatisfied postoperatively compared to patients who expected to be satisfied with performing work-related knee-straining activities. Simple logistic regression analyses revealed three prognostic factors; KOOS pain subscale, patients’ preoperativeexpectations and having a knee straining job. Multiple regression analyses revealed that only patients’ expectations were prognostic for being dissatisfied with performing work-related knee-straining activities at six months after TKA.

Conclusions: Two in ten working patients are dissatisfied with performing work-related knee-straining activities six months after TKA. Only preoperative patients’ expectations appeared prognostic. Therefore, we should take better care of working patients with low expectations by managing their preoperative expectations and improving their performance of work-related knee-straining activities in occupational rehabilitation.

Implications: First, physiotherapists can identify preoperative expectations of dissatisfaction in working patients and 1. communicate these expectations to the patient and involved (occupational) health care professionals and 2. address these expectations, with their knowledge of setting realistic goals in occupational rehabilitation combined with their patient motivation skills.
Second, physiotherapists can aim for better functional outcomes in occupational rehabilitation for working TKA patients. For instance, by setting specific goals regarding the work-related knee-straining activities a patient must perform at work.

Funding acknowledgements: For this work no funding was received

Keywords:
Total Knee Arthroplasty
Dissatisfaction
occupational rehabilitation

Topics:
Occupational health & ergonomics
Disability & rehabilitation
Musculoskeletal: lower limb

Did this work require ethics approval? No

Reason: The Medical Research Involving Human Subjects Act (WMO) did not apply to this study (reference number W14_006#14.17.0021).