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Patient-related and work-related factors play an important role in return to work after total knee arthroplasty: a systematic review
  1. Thijs MJ Pahlplatz1,
  2. Matthias U Schafroth1,
  3. Paul PFM Kuijer2
  1. 1 Department of Orthopaedics, Academic Medical Centre, Amsterdam, The Netherlands
  2. 2 Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Academic Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Thijs MJ Pahlplatz, Department of Orthopaedics, Academic Medical Centre, Amsterdam, Meibergdreef 9, 1100 WC Amsterdam, The Netherlands; t.m.pahlplatz{at}


Importance A growing group of patients with a total knee arthroplasty (TKA) are still working at the time of the surgery. The average time to return to work (RTW) is estimated at 3–6 months. There is a large range of time that patients need to RTW.

Objective The objective of this review is to systematically identify beneficial and limiting factors that affect RTW after TKA.

Evidence review PubMed and Embase were searched systematically to find studies that analysed prognostic factors for RTW in patients undergoing TKA. The following inclusion and exclusion criteria were used: patients with a TKA, studies that reported on RTW after TKA, patients had to be between 18 and 65 years and beneficial or limiting factors affecting RTW were described. Studies were included if written in English, German, French or Dutch. The Quality-in-Prognostic-Studies tool was used for the quality assessment of the included studies.

Findings 11 of the 306 primarily identified studies met the inclusion criteria. 7 patient-specific and 11 work-related factors were beneficial for a faster RTW, like being male and having a high job qualification. There were three patient-specific and eight work-related factors that were limiting factors for the RTW, like being female and preoperative sick leave.

Conclusions and relevance Patients that are male, have a high sense of urgency to return to work, have a high job qualification, are self-employed, with limited sick leave are those that are most likely for a successful and fast RTW. With the use of these factors, patients can be earlier identified as requiring better guidance preoperative and postoperatively for a more successful RTW.

Level of evidence Level III.

  • Total Knee Arthroplasty (TKA)
  • Return to Work (RTW)
  • Prognosis
  • Beneficial Factors and Limiting Factors
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  • Contributors Each of the authors has read the final manuscript and concurs with its content. All authors have made a substantial contribution to the realisation of this study.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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