Abstract
Introduction
A large proportion of patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis in both knees and may consider either simultaneous or staged bilateral TKA. The implications of staged versus simultaneously bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared to the sum of days missed from each surgery for patients who underwent staged bilateral TKA.
Methods
The prospective arthroplasty registry at Hospital for Special Surgery was utilized. We identified 61 employed patients who had undergone staged bilateral TKA and 152 employed patients who had undergone simultaneous bilateral TKA and had completed the registry's return to work questionnaire. Baseline characteristics and patient reported outcome scores were evaluated. We used a linear regression model, adjusting for potential confounders including age, sex, pre-op BMI, and work type (sedentary, moderate, high activity, or strenuous), to analyze workdays lost after staged versus simultaneous bilateral TKA.
Results
Staged patients missed a mean total of 67.9±46.1 days of work across both TKA surgeries, compared to 46.5±29.0 days missed in the simultaneous group (p<0.001). In multivariate mixed regression analysis, adjusted for age, sex, BMI, ASA status, and work type, the staged group missed 16.9±5.7 more days of work compared to the simultaneous group (95%CI 5.8 to 28.1, p=0.003). Compared to sedentary work type, patients with high or strenuous work activity missed 19.4±9.4 (p=0.040) more total work days.
Conclusions
Employed patients undergoing simultaneous bilateral TKA missed 17 fewer days of work over the course of their surgical treatment and rehabilitation compared to those undergoing staged bilateral TKA. This information may be useful to surgeons counseling patients with bilateral knee osteoarthritis about staged versus simultaneous bilateral surgery.
