Total knee arthroplasty among working-age patients

The number of working-age patients receiving total knee arthroplasty for end-stage knee osteoarthritis is rapidly rising. Working-age patients represent a relatively new group of patients, as they do not only expect pain relief and improved quality of life after surgery, but also want and need to participate in the workforce again. However, literature of total knee arthroplasty among working-age patients is scarce. The aim of this thesis was therefore to expand our knowledge of working-age patients receiving total knee arthroplasty, from their preoperative state to postoperative outcomes using a biopsychosocial approach, with a specific focus on work.

It was found that working-age patients had positive outcomes after total knee arthroplasty with respect to physical impairments and activity limitations, but the length of recovery often takes longer than the expected three months. Those who returned to work after six months experienced more pain and worse physical functioning preoperatively, and after surgery had worse recovery of pain, stiffness and physical functioning. Furthermore, patients reported substantial work productivity losses one-year after surgery whereby patients dealing with pain catastrophizing reported even higher productivity losses. Finally, physical activity was measured objectively one-year after surgery, which revealed that working-age patients were mainly sedentary during the day. This puts them at risk for adverse health outcomes. We recommend a tailored approach for working-age patients who are planned for knee replacement, already starting during preoperative counselling and continuing during postoperative rehabilitation, in order to enhance recovery and facilitate return to work.