Returning to work after knee replacement

Many people who are of “working age” generally delay as long as they can knee replacement surgery. The reasons for delay are obvious in many cases. The patient is a primary provider. The patient is self-employed. The patient is wondering if they can delay the knee replacement until they have acquired enough sick time that they can retire and they get the surgery. The patient is concerned with how much time they will miss at work.

For those patients who will be returning to work, the frequent question is, “when can I go back to work?”

When do “working age” patients return to work following knee replacement?

In this January 2019 study (1) doctors examined what happened to patients who had a knee replacement and returned to work, or tried to return to work.  The doctors wanted to know if the patients not only returned to work but what type of duties and hours the resumed. The researchers had a working idea of what happened to these patients. One, that whether they had partial or total knee replacement, they would take the same amount of time to return to work. Two, that the physically demanding nature of the patient’s job would not impact the return to work status.

Study points:

  • 31 patients had total knee replacement, and 27 had undergone partial knee replacement.
  • Of all patients 91% patients returned to work.
  • 8.6% patients did not:
    • 4.3% retired,
    • 2.6% reported physical health reasons.
    • 1.7% had been made redundant or replaced at their job.
  • Patients returned to work after (average) 7.7 weeks (total knee replacement), and 5.9 weeks (partial knee replacement).
  • Rehabilitation, desire, and necessity promoted return to work. Pain, fatigue and medical restrictions impeded return to work.

Study : Why 46 patients did not return to work following knee replacement and 121 did

In a study of 167 patients from the University of Amsterdam examined why 46 knee replacement patients did not return to work and 121 did. (2)

  • The patents in this study were close to retirement age. The average age of the 167 patients was about 60 at the time of the surgery.
  • 58% of these patients had significant weight problems.
  • Thirty-one percent of the patients believed it was the physically demanding nature of their job that caused them to need a knee replacement.

46 patients did not return to work because:

  • Eight patients had significant enough complication related to the knee replacement that it made returning to work impossible.
  • Seven patients reported other medical issues that prevented them from working.
  • Thirty-one decided that they would retire without trying to return to work.

How long did it take the 121 patients of this study to return to work?

  • Eight patients returned to work within 1 month.
  • 50 patients were able to return to work within one to three months.
  • 43 patients were able to return to work within 3–6 months.
  • and 20 patients were able to return to work after 6 months.

70-80% of total knee replacement patients return to work within three to six months

Recently, a 2021 study (3) indicated that 70-80% of total knee replacement patients return to work within three to six months. In this study “according to participants, factors within the following four themes can contribute to a successful return to work: occupational, patient, rehabilitation and medical care. Incorporating these factors into the integrated care pathway for the “young” total knee replacement patients may increase the chances of a successful return to work.

Does Neuromuscular electrical stimulation help?

A January 2022 study (4) examined Neuromuscular electrical stimulation (NMES) which has been reported as an effective treatment method for quadriceps strengthening and which could attenuate muscle loss in the early total knee replacement  postoperative recovery period. The purpose of this randomized controlled trial, according to its authors, was to test whether postoperative use of Neuromuscular electrical stimulation on total knee replacement  patients results in increased quadriceps strength and ultimately improved functional outcomes.

  • Patients were randomized 2:1 into treatment (Neuromuscular electrical stimulation (NMES), 44 patients) or control (No Neuromuscular electrical stimulation (NMES), 22 patients).
  • Patients who used the device for an average of 200 minutes/week or more (starting 1 week postoperative and continuing through week 12) were considered compliant.
  • Baseline measurements and outcomes were recorded at 3, 6, and 12 weeks postoperatively, and included quadriceps strength, range of motion (ROM), resting pain, functional timed up and go (TUG), stair climb test, and knee injury and osteoarthritis outcome score (KOOS) and veterans rand 12-item health survey (VR-12) scores.
  • Patients in the treatment arm (NMES use) experienced quadriceps strength gains over baseline at 3, 6, and 12 weeks following surgery, which were statistically significant compared with controls with quadriceps strength losses at 3 and 6 weeks .  Use of a home-based application-controlled NMES therapy system added to standard of care treatment showed statistically significant improvements in quadriceps strength and TUG following TKA, supporting a quicker return to function.

The success or failure in returning to work after knee replacement

As demonstrated in the research above, many people have good success from total or partial knee replacement. But for some, results were not was expected.

In January 2020,(1) doctors in Sweden produced an ambitious study to try to understand why a patient was not happy with their knee replacement when there were no obvious reasons that they should be. Especially when the surgery went without complication and was considered successful.

Here are some of the problems the patient reported and how it hindered them in their daily routine or trying to get back to work.

  • Participants experienced “Pain and stiffness.” For some, problems did not improve during the first year as expected.
  • Despite being told pre-surgery that the the likely extent and duration of the postoperative pain could be expected to last up to 1 year, some were not happy due to having experienced continued pain for a long time. Pain at night and at rest was described as uncomfortable and worrisome. The participants described discomfort that encompassed the whole knee. The onset of new pain when performing their usual activities and movements created frustration.
  • Discontentment with annoying and long-lasting stiffness was another experience often mentioned by the participants. They expressed their disappointment over not being able to bend and straighten the knee as expected, and said that their knee joint did not feel the same as before.
  • Difficulties performing normal daily activities included:
    • standing to wash dishes,
    • vacuum cleaning,
    • cutting the grass,
    • working in the garden,
    • driving a car,
    • or performing their jobs;
      • symptoms that were mentioned as obstacles in performing these activities were
        • pain,
        • stiffness,
        • swelling,
        • weakness in the leg,
        • and not being able to trust the knee.
  • Patients also expressed disappointment with their inability or difficulty in performing their favorite recreational activities, such as biking, dancing, hunting, fishing, playing golf, skiing, hiking, swimming, and playing with their grandchildren.

1 McGonagle L, Convery-Chan L, DeCruz P, Haebich S, Fick DP, Khan RJ. Factors influencing return to work after hip and knee arthroplasty. Journal of Orthopaedics and Traumatology. 2019 Dec 1;20(1):9.
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.
3 Pahlplatz TM, Schafroth MU, Krijger C, Hylkema TH, van Dijk CN, Frings-Dresen MH, Kuijer PP. Beneficial and limiting factors in return to work after primary total knee replacement: Patients’ perspective. Work. 2021 Jan 1(Preprint):1-8.
4 Klika AK, Yakubek G, Piuzzi N, Calabrese G, Barsoum WK, Higuera CA. Neuromuscular electrical stimulation use after total knee arthroplasty improves early return to function: a randomized trial. The Journal of Knee Surgery. 2022 Jan;35(01):104-11.
5 Hah JM, Lee E, Shrestha R, Pirrotta L, Huddleston J, Goodman S, Amanatullah DF, Dirbas FM, Carroll IR, Schofield D. Return to work and productivity loss after surgery: A health economic evaluation. International Journal of Surgery. 2021 Nov 1;95:106100.

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