Predictors of Return to Work After High Tibial Osteotomy: The Importance of Being a Breadwinner

Alexander Hoorntje; P Paul F M Kuijer; Berbke T van Ginneken; Koen L M Koenraadt; Rutger C I van Geenen; Gino M M J Kerkhoffs; Ronald J van Heerwaarden

doi:10.1177/2325967119890056

Predictors of Return to Work After High Tibial Osteotomy: The Importance of Being a Breadwinner

Orthop J Sports Med. 2019 Dec 27;7(12):2325967119890056. doi: 10.1177/2325967119890056. eCollection 2019 Dec.

Authors

Alexander Hoorntje^{1

2

3

4}, P Paul F M Kuijer⁵, Berbke T van Ginneken⁶, Koen L M Koenraadt⁴, Rutger C I van Geenen⁴, Gino M M J Kerkhoffs^{2

3

4}, Ronald J van Heerwaarden^{7

6}

Affiliations

¹ Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
² Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.
³ Amsterdam Collaboration on Health & Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.
⁴ Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands.
⁵ Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁶ Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands.
⁷ Department of Orthopaedic Surgery, Maartenskliniek Woerden, Woerden, the Netherlands.

Abstract

Background: Limited evidence exists on patient-relevant outcomes after high tibial osteotomy (HTO), including return to work (RTW). Furthermore, prognostic factors for RTW have never been described.

Purpose: To investigate the extent and timing of RTW in the largest HTO cohort investigated for RTW to date and to identify prognostic factors for RTW after HTO.

Study design: Cohort study; Level of evidence, 3.

Methods: Consecutive patients who underwent HTO between 2012 and 2015 were included. Patients received a questionnaire at a mean follow-up of 3.6 years. Questions were asked pre- and postoperatively regarding work status, job title, working hours, preoperative sick leave, employment status, and whether patients were their family's breadwinner. The validated Work Rehabilitation Questionnaire (WORQ) was used to assess difficulty with knee-demanding activities. Prognostic factors for RTW were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph.

Results: We identified 402 consecutive patients who underwent HTO, of whom 349 were included. Preoperatively, 299 patients worked, of whom 284 (95%) achieved RTW and 255 (90%) returned within 6 months. Patients reported significant postoperative improvements in performing knee-demanding activities. Being the family's breadwinner was the strongest predictor of RTW (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.27-6.69). In contrast, preoperative sick leave was associated with lower odds of RTW (OR, 0.20; 95% CI, 0.08-0.46).

Conclusion: After HTO, 95% of patients were able to RTW, of whom 9 of 10 returned within 6 months. Breadwinners were more likely to RTW, and patients with preoperative sick leave were less likely to RTW within 6 months. These findings may be used to improve preoperative counseling and expectation management and thereby enhance work-related outcomes after HTO.

Keywords: directed acyclic graph; employment; high tibial osteotomy; knee osteoarthritis; prognostic factor; return to work.