IRSST - Institut de recherche Robert-Sauvé en santé et en sécurité du travail

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Knee Surgery: Factors Hindering the Return to Work


Knee Surgery: Factors Hindering the Return to Work

Knee arthroplasty, or replacement of the knee joint, is an increasingly frequent procedure. Yet returning to work after such surgery is not always easy. Sometimes the usual medical follow-up is not enough to help workers who have had this surgery to return to their job, particularly if the job is physically demanding.

In Canada, the number of knee arthroplasties soared by 139% between 1998/1999 and 2008/2009. It was mainly workers between the ages of 45 and 54 who underwent this surgery, which consists of replacing the entire knee joint by a prosthesis.

Several factors may explain this phenomenon, including the improved lifespan of prostheses, which allows the operation to be performed on patients at a younger age.  Also, aging workers want to continue working longer.

How then can we facilitate the return to work of these people? A research team funded by the IRSST (Institut de recherche Robert-Sauvé en santé et en sécurité du travail) investigated this question. A study headed by Marie-France Coutu, a researcher and professor at the Université de Sherbrooke in Québec, shed light on the facilitating factors, but also on the factors hindering the return to work after this type of surgery.

The study involved the in-depth analysis of 17 situations involving workers with physical jobs and who had undergone total knee replacement and were trying to return to work. They were classified in three groups:

  • returned to work with little or no difficulty;
  • returned to work with difficulty;
  • unable to return to work.

The workers were interviewed from 3 to 12 months post-surgery. To gain a full understanding of the situation, their employers and unions were also interviewed. The work activity of the individuals who had returned to work was analyzed briefly. Lastly, their health professional was interviewed.

Winning Conditions for a Sustainable Return to Work

First, workers must believe that they can manage their residual symptoms, if any. Next, the key to success lies mainly in the work environment.

The researchers observed that those who were back at work with little or no difficulty had the opportunity to apply adaptive strategies to perform their tasks. For example, one of these workers built himself a little bench where he could take a minute to sit down. Others did stretching exercises during their breaks. In some cases, the employers accommodated the workers by delegating some of their tasks to other workers, and occasionally by permitting a gradual return to work.

“We’ve suspected it for a long time, but now we know that a return to work does not depend solely on the worker’s willingness. There are aspects of the work environment that absolutely must be taken into account,” explained the researcher.

She added that some workers had adapted their expectations to bring them more into line with their new capacities. The research team further recommended that orthopaedists discuss with their patients both the demands of their job and their expectations. Lastly, when the return to work proves difficult, rehabilitation may help workers obtain the support they need.

Adapted Rehabilitation

The vast majority of the participants in this study were not receiving compensation for a work-related accident, although several of them had private insurance. It appears that work rehabilitation and measures facilitating the return to work are very rarely offered to workers with private insurance who have undergone total knee replacement and who perform physically demanding jobs, contrary to workers with musculoskeletal disorders.

“Arthroplasty performed on workers who hope to return to work afterwards is a relatively recent phenomenon. Workplaces are thus in the process of adapting to this new reality,” added Professor Coutu.

It is important to point out that certain workers probably do not need a work rehabilitation program, judging from the participants in the group that returned to work with little or no difficulty. However, the vast majority of workers want to return to work gradually. According to the researcher, we need to be able to identify those with specific rehabilitation needs if we are to support them more effectively in their return to work.

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Obstacles et facilitateurs du retour et du maintien durable en emploi après une arthroplastie totale du genou (factors hindering and facilitating sustainable return to work following total knee replacement) ● Authors: Marie-France Coutu, Nathaly Gaudreault, Marie-Eve Major, Iuliana Nastasia, Réjean Dumais, Annie Deshaies, Marie-Elise Labrecque, Sara Pettigrew, Pascale Maillette ● R-106