Working through knee arthroplasty recovery: impact of socio-professional categories on return to work after knee arthroplasty. A prospective study of 120 patients.

BACKGROUND

Knee osteoarthritis increasingly affects active adults under 65 years of age. As total and unicompartmental knee arthroplasty (TKA/UKA) become common treatments, return to work (RTW) emerges as a key milestone in recovery. While age, obesity, and comorbidities have been identified as predictors, the specific impact of professional occupation remains underexplored. This prospective study addresses this gap by investigating (1) how socio-professional category (SPC) influences the duration of sick leave after knee arthroplasty; and (2) whether physically demanding jobs; higher body mass index (BMI), age, and/ or other demographic or clinical factors are associated with prolonged sick leave.

HYPOTHESIS: The authors hypothesized that the type of profession is the most significant predictor of extended sick leave following knee arthroplasty.

METHODS

A prospective, single-center study was conducted involving 120 professionally active patients aged 18-65 years who underwent TKA or UKA between February 2020 and December 2023. Sociodemographic data, job classification (using PCS-ESE 2017), job physical demands, and clinical characteristics were collected. RTW status was evaluated at three months postoperatively, with an additional follow-up at four months for patients with extended sick leave (>90 days). Univariate and multivariate logistic regression analyses were performed to identify predictors of prolonged sick leave (> 90 days).

RESULTS

While patients in SPC-3 (executives and intellectual professions) and SPC-5 (employees) were significantly associated with prolonged sick leave in univariate analysis (OR = 0.35; 95% CI: 0.15-0.81; p = 0.014 and OR = 3.95; 95% CI: 1.73-8.98; p = 0.001, respectively), neither association was confirmed in multivariate analysis (SPC-3: OR = 1.52; 95% CI: 0.47-4.88; p = 0.484; SPC-5: OR = 2.41; 95% CI: 0.89-6.51; p = 0.0837). Secondly, physically demanding jobs strongly predicted extended sick leave, with nearly a fivefold increase in risk (OR = 4.58 95% CI:1.63-12.87; p = 0.0038). Thirdly, while a trend was observed for higher BMI to be associated with longer sick leave (OR = 1.09; 95% CI: 0.99-1.19; p = 0.060), no significant associations were found for sex, age, ASA score, length of hospital stay, discharge modality, or caregiver availability.

CONCLUSION

Physically demanding occupations and not professional status are the main factors delaying return to work after knee arthroplasty. In contrast, traditional demographic factors such as sex, BMI and ASA score appear less influential. These findings highlight the importance of integrating occupational context and modifiable risk factors into preoperative planning to facilitate earlier RTW and optimize patient recovery trajectories.

LEVEL OF EVIDENCE: II; prospective study.