WHAT WORK-RELATED ACTIVITIES CAN PATIENTS PERFORM 6 MONTHS AFTER TOTAL KNEE ARTHROPLASTY AND WHAT WAS EXPECTED PREOPERATIVELY?

Y. van Zaanen1, T.M.P. Pahlplatz2, R.C. van Geenen3, A.J. Kievit2, M.J. Hoozemans4,5, L. Blankevoort2, M.U. Schafroth2, D. Haverkamp6, T.M. Vervest7, D.H. Das8, W. van der Weegen8, V.A. Scholtes9, M.H. Frings-Dresen1, 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, 4Noordwest Ziekenhuisgroep, CORAL - Center for Orthopaedic Research Alkmaar, Department of Orthopaedics, Alkmaar, Netherlands, 5Vrije Universiteit Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam, Netherlands, 6Xpert Orthopaedics, Amsterdam, Netherlands, 7Tergooi Hospital, Department of Orthopaedic Surgery, Hilversum, Netherlands, 8St. Anna Hospital, Department and Research Center of Orthopaedic Surgery, Geldrop, Netherlands, 9OLVG+, Joint Research Orthopedic Surgery, Amsterdam, Netherlands

Background: Worldwide, the incidence of Total Knee Arthroplasty (TKA) is increasing in the working population. Of these TKA patients, 3 out of 10 do not return to work after surgery. Little is known regarding the ability to perform work-related activities 6 months postoperative. Physiotherapists engaged in rehabilitation of working patients are often asked for advice when work-related activities can be resumed. Unfortunately, no studies are available that have assessed this outcome prospectively.

Purpose: Therefore, the research question is: ‘What work-related activities can patients perform 6 months after Total Knee Arthroplasty and are these in line with preoperative patient expectations?’

Methods: A multi-center prospective study was performed among 236 working TKA patients in the Netherlands. Pre- and postoperative, the Work Osteoarthritis or joint-Replacement Questionnaire (WORQ) was used to assess the expected and the actual ability to perform 13 work-related activities at 6 months after surgery, like kneeling and lifting. This was done on a five point scale: extreme difficulty or unable to perform(0), severe(1), moderate(2), mild(3) and no difficulty at all’(4). Based on the scores of these 13 items, an overall WORQ score can be calculated ranging from 0 (‘extreme difficulties’) to 100 (‘no difficulties at all’)(Kievit et al. 2014). The difference between the expected overall WORQ score and the actual overall WORQ score was tested using the Mann-Whitney test. A p-value <0.05 was deemed significant. In addition, for each of the 13 work-related activities, the percentage of patients reporting a postoperative score of extreme or severe difficulty (score 0 and 1 on the scale) were compared to these preoperative patient scores.

Results: The response rate was 85% (n=201). The median age of working TKA patients was 59 years (52% female). Six months postoperative, the median overall WORQ score was 67 [IQR 54-81]. Preoperative, the expected WORQ score for 6 months postoperative was 75 [IQR 60-85]. This difference was statistically significant (p< 0.01). The largest percentage of patients reported severe or extreme difficulty 6 months after surgery for kneeling (70%), crouching (60%), clambering (29%) and working with hands below knee height (18%). Before surgery, the corresponding percentages were kneeling 34%, crouching 30%, clambering 17% and working with hands below knee height 11%.  

Conclusion(s): A majority of working patients experience difficulty with the work related-activities kneeling and crouching 6 months after TKA. Pre-operative patient expectations regarding ability to perform work-related activities were higher than the actual ability 6 months after TKA, especially for kneeling, crouching, clambering and working with hands below knee height. Variation in preoperative expectations and 6 months postoperative ability was large between working patients.

Implications: These data on ability to perform work-related activities 6 months after TKA are helpful as reference to guide working age patients regarding their postoperative work ability.
Patient expectations regarding the ability to perform work-related activities preoperatively, can be discussed using the 13-items WORQ questionnaire.
By incorporating these patient outcomes regarding the work ability 6 months postoperative, realistic vocational rehabilitation goals can be set, for instance by using Goal Attainment Scaling.

Funding, acknowledgements: Paul Kuijer has received personal funding from Anna Fonds, NOREF

Keywords: Total Knee Arthroplasty, Vocational rehabilitation, Work-related activities

Topic: Occupational health & ergonomics

Did this work require ethics approval? No
Institution: Amsterdam UMC, Location AMC, Meibergdreef 9 Amsterdam
Committee: METC Amsterdam UMC
Reason: The Medical Research Involving Human Subjects Act (WMO) did not apply to this study (reference number W14_006#14.17.0021).


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