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Preoperative Predictors of Returning to Work Following Primary Total Knee Arthroplasty
Joseph F. Styron, PhD1; Wael K. Barsoum, MD2; Kathleen A. Smyth, PhD1; Mendel E. Singer, PhD1
1 Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Wood Building WG-57, 10900 Euclid Avenue, Cleveland, OH 44106-4945. E-mail address for J.F. Styron: jxs178@case.edu
2 Department of Orthopaedic Surgery, Cleveland Clinic, Mail Code A-41, 9500 Euclid Avenue, Cleveland, OH 44195
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Agency for Healthcare Research and Quality (Institutional Training Grant T32 HS00059). In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Stryker, S.S. White, Wright Medical, OtisMed, and Exactech).

A commentary by Thomas Parker Vail, MD, is available at www.jbjs.org/commentary and is linked to the online version of this article.
Investigation performed at the Cleveland Clinic and the School of Medicine, Case Western Reserve University, Cleveland, Ohio

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jan 05;93(1):2-10. doi: 10.2106/JBJS.I.01317
A commentary by Thomas Parker Vail, MD, is available here
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There is little in the literature to guide clinicians in advising patients regarding their return to work following a primary total knee arthroplasty. In this study, we aimed to identify which factors are important in estimating a patient's time to return to work following primary total knee arthroplasty, how long patients can anticipate being off from work, and the types of jobs to which patients are able to return following primary total knee arthroplasty.


A prospective cohort study was performed in which patients scheduled for a primary total knee arthroplasty completed a validated questionnaire preoperatively and at four to six weeks, three months, and six months postoperatively. The questionnaire assessed the patient's occupational physical demands, ability to perform job responsibilities, physical status, and motivation to return to work as well as factors that may impact his or her recovery and other workplace characteristics. Two survival analysis models were constructed to evaluate the time to return to work either at least part-time or full-time. Acceleration factors were calculated to indicate the relative percentage of time until the patient returned to work.


The median time to return to work was 8.9 weeks. Patients who reported a sense of urgency about returning to work were found to return in half the time taken by other employees (acceleration factor = 0.468; p < 0.001). Other preoperative factors associated with a faster return to work included being female (acceleration factor = 0.783), self-employment (acceleration factor = 0.792), higher mental health scores (acceleration factor = 0.891), higher physical function scores (acceleration factor = 0.809), higher Functional Comorbidity Index scores (acceleration factor = 0.914), and a handicap accessible workplace (acceleration factor = 0.736). A slower return to work was associated with having less pain preoperatively (acceleration factor = 1.132), having a more physically demanding job (acceleration factor = 1.116), and receiving Workers’ Compensation (acceleration factor = 4.360).


Although the physical demands of a patient's job have a moderate influence on the patient's ability to return to work following a primary total knee arthroplasty, the patient's characteristics, particularly motivation, play a more important role.

Level of Evidence: 

Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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