Prevention at work needed to curb the worldwide strong increase in knee replacement surgery for working-age osteoarthritis patients

Abstract

Prevention at work needed to curb the worldwide strong increase in knee replacement surgery for working-age osteoarthritis patients In the upcoming decades, hospitals and clinics around the world face a steep rise in demand from patients seeking knee replacement surgery. An absolute increase in knee replacement surgery of 297%-to 57 893 procedures-is forecasted in The Netherlands between 2005 and 2030 (1). The situation is similar in many countries: Sweden, 163% to 21 700 (2013-2030) (2); Italy, 45% to about 100 000 (2017-2050) (3), the UK, 916% to about 1.2 million (2015-2035) (4); Australia, 276% to 65 569 (2013-2030) (5); and the USA, 673% to 3.48 million (2005-2030) (6). No projections are available for Asia, however, similar growth percentages have already been seen in Japan of 373% (2007-2014) (7) and Korea (407%, 2001-2010) (8). Knee replacement surgery or arthroplasty is the final treatment option for patients suffering from knee osteoarthritis (OA). These increasing numbers are alarming, not only due to the extreme high demands on healthcare provision and budgets, but also for the unforeseen impact on work participation. There is a lack of awareness how work might play a significant role in reducing the steep rise in replacement surgery for knee OA across the world. Unforeseen impact on work The largest increase in primary surgery demands is not among the classic knee arthroplasty population of patients aged 70 years and older, but among patients of working age (1-4, 9). For instance, Germany-one of the leading countries in the prevalence of knee arthroplasty-foresees the highest increase in patients aged 50-65 years until 2050 (10), and in a similar study using the same database even among patients aged 40-49 years until 2040 (11). In several countries, the current proportion of knee arthroplasty patients under 65 years is already substantial at 30-40%. It is expected in 2030 that the USA will be the first country where the majority of these patients will be younger than 65 years (6), followed by the UK in 2035 (4). This increase in surgery and shift towards younger age groups can largely be explained by good clinical and cost-effective long-term outcomes, no clear threshold for surgery, and the rising number of younger and more demanding knee OA patients (9). Originally, knee arthroplasty was mainly aimed at reducing pain, improving knee function and thereby enhancing the performance of activities of daily life in the patient population aged 70 years and older. The current success was totally unforeseen by LG Shiers, the founding father of knee arthroplasty (12). In 1954, he concluded: "… few surgeons will ever see 50 patients requiring arthroplasty, let alone operate on them, even in five years". Nowadays, specialized orthopedic surgeons perform this procedure several times per day. Despite the good clinical outcomes, return to work is not that favorable after surgery. About two of every ten working-age patients are dissatisfied with their work ability due to their knee arthroplasty (13). The majority...

Does Consulting an Occupational Medicine Specialist Decrease Time to Return to Work Among Total Knee Arthroplasty Patients? A 12-Month Prospective Multicenter Cohort Study

“…Recently the Dutch multidisciplinary practice guideline for occupational health professionals was developed for patients with low back pain and lumbosacral radicular syndrome [24]. Following this example a multidisciplinary occupational health guideline on prevention and work participation of knee osteoarthritis patients, as well as pre-and postoperative care in TKA patients can be of help for informed decision making and alleviate the burden of knee OA and TKA on patients, employers, health care and society [3,8]. A second explanation might be that the timing of the consult with an OMS is not early enough to establish a decrease in time to RTW.…”

“…Worldwide there is a steep rising demand for total knee arthroplasty (TKA), especially among patients of working age. By 2030-2035 the majority of TKA patients in the US and UK will already be of working age [1][2][3]. Return to work (RTW) rates among these TKA patients vary between 40 and 98% with a mean time to return to work between 8 and 17 weeks [4,5].…”

Return to Work Following Knee Arthroplasty

“…For many patients, returning to work will require them to accept the fact that their "new" KA knee will not function as their healthy knee. The largest increase in primary KA demands is namely not among the classic knee arthroplasty population of patients aged 70 years and older but among patients of working age [1]. For instance, the number of patients aged 45-65 years who undergo total knee arthroplasty (TKA) has tripled (Swedish knee arthroplasty register) in the past 30 years.…”

Large variability in recommendations for return to daily life activities after knee arthroplasty among Dutch hospitals and clinics: a cross-sectional study

“…In the most recent years, the number of knee arthroplasty (KA) procedures has increased rapidly due to the rising obesity prevalence, the ageing society, and the wish to remain active at a higher age (1)(2)(3)(4). For example, in the Netherlands, it is expected that there will be ~57,900 KAs in 2030 (5), a growth of 297% compared with 2005.…”