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J Occup Rehabil. 2009 Dec;19(4):375-81. doi: 10.1007/s10926-009-9192-1. Epub 2009 Aug 20.

Beneficial and limiting factors affecting return to work after total knee and hip arthroplasty: a systematic review.

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Coronel Institute of Occupational Health, People and Work Outpatient Clinic, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands.



A large number of patients undergoing total knee (TKA) and hip (THA) arthroplasties are of working age at the time these procedures are performed. The objective of this study was to systematically review literature on the beneficial and limiting factors affecting return to work in patients undergoing TKA or THA.


Pubmed and Embase were systematically searched to find studies that described factors that influence return to work (RTW) after surgery. The following inclusion criteria had to be met: (1) inclusion of patients with primary or revision TKA or THA; (2) description of return to work after surgery or employment status; and (3) description of a beneficial or restricting factor affecting return to work.


Only three studies were found that fulfilled the three inclusion criteria. Three factors were discussed: (1) the mini-posterior approach compared to the two-incision approach; (2) patient movement restrictions after surgery compared to no restrictions; and (3) patient discharge based on guidelines compared to discharge without guidelines.


This systematic review revealed that knowledge is sparse regarding beneficial or limiting factors affecting return to work after TKA or THA. Despite that, the results suggests that the two-incision approach is beneficial, patient movement restrictions are limiting, and patient discharge guidelines have no effect on the time patients take to RTW.

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