Aims. The primary aim of this study was to determine the rates of return to work (RTW) and sport (RTS) following a humeral shaft fracture. The secondary aim was to identify factors independently associated with failure to RTW or RTS. Methods. From 2008 to 2017, all patients with a humeral diaphyseal fracture were retrospectively identified. Patient demographics and injury characteristics were recorded. Details of pre-injury employment, sporting participation, and levels of return post-injury were obtained via postal questionnaire. The University of California, Los Angeles (UCLA) Activity Scale was used to quantify physical activity among active patients. Regression was used to determine factors independently associated with failure to RTW or RTS. Results. The Work Group comprised 177 patients in employment prior to injury (mean age 47 years (17 to 78); 51% female (n = 90)). Mean follow-up was 5.8 years (1.3 to 11). Overall, 85% (n = 151) returned to work at a mean of 14 weeks post-injury (0 to 104), but only 60% (n = 106) returned full-time to their previous employment. Proximal-third fractures (adjusted odds ratio (aOR) 4.0 (95% confidence interval (CI) 1.2 to 14.2); p = 0.029) were independently associated with failure to RTW. The Sport Group comprised 182 patients involved in sport prior to injury (mean age 52 years (18 to 85); 57% female (n = 104)). Mean follow-up was 5.4 years (1.3 to 11). The mean UCLA score reduced from 6.9 (95% CI 6.6 to 7.2) before injury to 6.1 (95% CI 5.8 to 6.4) post-injury (p < 0.001). There were 89% (n = 162) who returned to sport: 8% (n = 14) within three months, 34% (n = 62) within six months, and 70% (n = 127) within one year. Age ≥ 60 years was independently associated with failure to RTS (aOR 3.0 (95% CI 1.1 to 8.2); p = 0.036). No other factors were independently associated with failure to RTW or RTS. Conclusion. Most patients successfully return to work and sport following a humeral shaft fracture, albeit at a lower level of physical activity. Patients aged ≥ 60 yrs and those with proximal-third diaphyseal fractures are at increased risk of failing to return to activity. Cite this article: Bone Jt Open 2022;3(3):236–244

It is undetermined which factors predict return to work following arthroscopic rotator cuff repair. We aimed to identify which factors predicted return to work at any level, and return to pre-injury levels of work 6 months post-arthroscopic rotator cuff repair. Multiple logistic regression analysis of prospectively collected demographic, pre-injury, preoperative, and intraoperative data from 1502 consecutive primary arthroscopic rotator cuff repairs, performed by a single surgeon, was performed to identify independent predictors of return to work, and return to pre-injury levels of work respectively, 6 months post-surgery. Six months post-rotator cuff repair, 76% of patients returned to work (RTW), and 40% returned to pre-injury levels of work (Full-RTW). RTW at 6 months was likely if patients were still working after their injuries, but prior to surgery (Wald statistic [W]=55, p<0.0001), were stronger in internal rotation preoperatively (W=8, p=0.004), had full-thickness tears (W=9, p=0.002), and were female (W=5, p=0.030). Patients who achieved Full-RTW were likely to have worked less strenuously pre-injury (W=173, p<0.0001), worked more strenuously post-injury but pre-surgery (W=22, p<0.0001), had greater behind-the-back lift-off strength preoperatively (W=8, p=0.004), and had less passive external rotation range of motion preoperatively (W=5, p=0.034). Patients who were still working post-injury, but pre-surgery were 1.6-times more likely to RTW than patients who were not (p<0.0001). Patients who nominated their pre-injury level of work as “light” were 11-times more likely to achieve Full-RTW than those who nominated “strenuous” (p<0.0001). Six months post-rotator cuff repair, a higher patient-rated post-injury, but pre-surgery level of work was the strongest predictor of RTW. A lower patient-rated pre-injury level of work was the strongest predictor of Full-RTW. Greater preoperative subscapularis strength independently predicted both RTW, and Full-RTW

Abstract. Introduction. Little is known about employment following revision total knee arthroplasty (RTKA). This study aims to describe factors associated with returning to employment in patients of working age who underwent RTKA surgery. Methodology. We performed a retrospective assessment of all patients aged ≤65 who underwent RTKA at our NHS institution between 2006 and 2020. All indications and revision procedures were included. Pre-operative demographics, indication for surgery and Oxford Knee Scores (OKS) were recorded. Postal questionnaires were sent to patients including patient reported outcome measures and departmental questionnaire asking patients about employment status pre- and post-operatively. Results. 132 procedures were performed in 113 patients. Median follow up was 5.5 years (2.4–9.0). Mean age was 58 (5.8) and 50% (57) were male. 62 patients undergoing 74 procedures responded to postal questionnaires and were included in the study. 53% (33) were employed prior to surgery and 61% (38) returned to work at a median of 12 weeks (3–150). Of the 24 who did not return to work, 7 reported intending to return to work. Those patients who returned to work had increased pre-operative OKS (16.9 vs 13.6) and mean improvement (16.5 vs 12.4). Conclusion. This study is limited by small numbers and its observational nature. In this population the majority of patients who wished to return to work after RTKA were able to do so. This provides some reassurance when counselling patients. Prospective studies to better understand the factors that predict return to work will be important with increasing demands from surgery

Introduction. Early intervention is advocated to prevent long-term work absence due to musculoskeletal (MSK) pain. The SWAP trial tested whether adding a vocational advice (VA) service to best current care led to fewer days work absence over 4 months. Methods. The SWAP trial was a cluster randomised controlled trial in 6 general practices, 3 randomised to best current care (control), 3 randomised to best current care and the VA service (intervention). Patients were ≥18 years, absent from work ≤6 months or struggling at work due to MSK pain. Primary outcome was number of days absent over 4 months. Exploratory subgroup analyses examined whether the effect was larger for patients with spinal pain compared to other MSK pain. Results. 338 participants (158 intervention, 180 control) were recruited with 79% followed-up at 4 months. Participants in the intervention arm had significantly fewer days absent over 4 months (mean 9.3 days, SD 21.7) compared with control (mean 14.4 days, SD 27.7); adjusted incidence rate ratio (IRR) 0.51 (0.26, 0.99), p=0.048. This difference was largely due to fewer GP certified absent days (8.4 days versus 13.5 days). At 12 months the effect of the VA service was significantly greater in those with spinal pain compared to patients with other MSK problems (IRR. interaction. : 0.25 (95% Confidence Interval 0.10, 0.62) (p . interaction. =0.003). Conclusions. Adding a VA service to best current primary care for MSK pain leads to significantly fewer days absent from work over 4 months, with exploratory analysis indicating the VA service is particularly effective for patients with spinal pain. No conflicts of interest. This paper presents independent research funded by the National Institute for Health Research (NIHR), under its Programme Grants for Applied Research funding scheme: “Optimal management of spinal pain and sciatica in primary care” (NIHR-RP-PG-0707-10131). NEF and AB are funded by an NIHR Research Professorship (NIHR-RP-011-015). NEF and EMH are NIHR Senior Investigators. GW-J is funded by an NIHR Post-Doctoral Fellowship (PDF-2009-02-54). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health

The future of work brings several challenges and opportunities for occupational health and safety on three major drivers: the rapid progress of technological innovation; demographic changes, in particular ageing of the workforce and migration; and changes in the labour market, especially owing to new ways of per-forming jobs. Innovation technologies are leading to an overall transformation of industrial processes that offer huge developmental perspectives in the world of work and opportunities for society. In the field of prevention of musculoskeletal disorders, relevant progresses have been made in the clinical setting and in the context of care, also in relation to the ageing society. In the near future, the adaptation of workstations and the implementation of sensors and enabling technologies (collaborative robots and exoskeletons) will offer, together with the innovations in the clinic and orthopaedic surgery, a significant contribution to the reduction of risks from biomechanical overload, as well as support interventions to increase work ability and reduce the impact of disability. However, the potential risk scenarios for health and safety in the workplace, along with the progress in occupational health research, lead to the need for creating an inte-grated system of skills and approaches to adopt a Prevention through Design perspective. This requires designing and conceiving processes taking into consideration occupational risk prevention and guarantee-ing the return to work in a multidisciplinary and integrated perspective

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

Introduction. Recent literature has sought to quantify pre-operative work associated with total joint arthroplasty. These studies have utilized surveys or self-reported time logs to estimate the Pre-op Optimization Work (POW) completed by the surgical team. The purpose of this study was to objectively quantify POW associated with total hip arthroplasty (THA) using electronic medical record (EMR) activity audit logs. Methods. Retrospective analysis of EMR activity for 4 arthroplasty surgeons and their clinical staff was collected for 100 consecutive THA cases (25 per surgeon). Clinical informatics data was generated using EMR activity audit logs for pre-THA activity. Every action and mouse-click within a patient's chart was recorded for each team member. The time between mouse-clicks was calculated and summed for each user. Times exceeding five minutes without activity were assumed to reflect inactivity and excluded. Descriptive statistics were used to estimate the POW associated with THA preparation. Results. The mean number of days for pre-THA time period was70.7 (SD43.9; range: 8–175days). During this period, the mean time spent in each patient's chart was 75.5 minutes (SD50.75) minutes. Surgeon's POW in the medical record accounted for 7.3(SD6.7) of these minutes. Much of the work was conducted by nurses (47.0 minutes, SD43.4), physician extenders (10.8 minutes, SD 13.1), and qualified office staff/technicians (10.4 minutes, SD14.9). The majority of work captured in the EMR activity log was associated with medication review, patient optimization, documentation of necessary medical clearances, ordersets, patient communication, and prior authorization requests. Conclusion. A considerable amount of preoperative work is required between the clinic date a patient decides to pursue THA and the day prior to surgery. These retrospective electronic time stamp measurements should represent the absolute minimum time required for surgical preparation

Purpose. The purpose of this study was to investigate the rate of return to work after total knee arthroplasty (TKA). Materials and Methods. 105 knees of 80 cases were tested after TKA surgery. 18 knees of 14 cases were men and 87 knees of 66 cases were women. The average age at the time of surgery was 71.5 years, and the average postoperative observation period was 25.5 months. All patients were with osteoarthritis of the knee. The use models were Hi-tech Knee II (Nakashima Medical, Okayama, Japan) CR type 99 knees and PS type 6 knees. The rate of return to work after surgery and employment rate of before and after surgery were examined for all cases. In addition,[1]age at surgery [2]ROM [3]JKOM score(Akai 2006) [4]Knee Society score (KSS Insall 1989) were examined in each case, and found the factors influenced on employment rate after TKA. The occupation was classified using major group of the International Standard Classification of Occupations (ISCO-08) defined by International Labour Organization (ILO) on 2007. Mann-Whitney U test was used for the statistical work. Results. Preoperative and postoperative employment state was shown in the Fig.1. 29 knees of 23 cases were in employment before surgery. In these cases, 22 knees of 18 cases had return to work after surgery (Group I) and 7 knees of 5cases had retired after surgery(Group II). 76 knees of 57cases were unemployed before and after surgery(Group III). Return to work rate was 78.3 percent after TKA. In the Group I, all cases returned to the same occupation before surgery. The average age of the Group III at the time of surgery was significantly higher than Group I and II(Fig.2). Compared KSS, postoperative functional score of the group I was significantly higher than Group II and III(Fig.3). Discussion. The cases employed before TKA were younger than the unemployed cases. In the cases returned to work after TKA, stairs rise-and-fall capability and walking ability were higher than the other cases. Conclusion. (1)The rate of return to work was 78.3 percent after TKA.(2)Age at surgery influenced the preoperative employment.(3)Stairs rise-and-fall capability and walking ability after surgery involved the return to work

Background. Individual illness perceptions have been shown to be important influences on clinical outcomes for low back, yet significant others' illness perceptions are rarely explored, particularly in relation to work disability. Method. Semi-structured interviews based on the Illness Perceptions Questionnaire were conducted with a purposive sample of UK disability benefit claimants, along with their significant others (n=5 dyads). Data were analysed using template analysis. Results. Significant others further reinforced and validated claimants' negative beliefs/illness perceptions, including fear of pain/re-injury associated with certain types of work, perceived job inflexibility and/or lack of support from employers. Keen in their desire to be viewed as a ‘good’ spouse/partner/close family member, significant others acted as a ‘witness to pain’, supporting claimants' self-limiting behaviour and statements of incapacity, often responding with assistance and empathy. In some cases, significant others were more pessimistic about the likelihood of claimants returning to work, and more resigned to the permanence of the claimant's condition. Interestingly, all significant others also experienced chronic illness, some being disability benefit claimants themselves, thus participants' lives were often intertwined and defined by illness. Conclusions. This exploratory study reveals novel and interesting insights about the illness beliefs and behaviours of significant others in relation to disabling back pain, and also the wider social circumstances that may act as obstacles to return to work. Conflicts of Interest. None. Source of Funding. BackCare and NHS Blackburn with Darwen

Background: Increasing employment and supporting people into work are key elements of the UK Government’s public health and welfare agendas. There are economic, social and moral arguments that work is the most effective way to improve the well-being of individuals, their families and their communities. There is also growing awareness that (long-term) worklessness is harmful to physical and mental health, so the corollary might be assumed – that work is beneficial for health. However, that does not necessarily follow. This review fills that gap by collating and evaluating the evidence on the question ‘Is work good for your health and well-being?’ This forms part of the evidence base for the Health, Work and Well-Being Strategy. Methods: This review approached the question from various directions and incorporated an enormous range of scientific evidence, of differing type and quality, from a variety of disciplines, methodologies and literatures. It a) evaluated the scientific evidence on the relationship between work, health and well-being; and b) to do that, it also had to make sense of the complex set of issues around work and health. This required a combination of a) a ‘best evidence synthesis’ that offered the flexibility to tackle heterogeneous evidence and complex sociomedical issues, and b) a rigorous methodology for rating the strength of the scientific evidence. The review focused on adults of working age and the common health problems (mild/moderate mental health, musculoskeletal and cardio-respiratory conditions) that account for two-thirds of sickness absence and long-term incapacity. Findings. Work: The generally accepted theoretical framework about work and well-being is based on extensive background evidence:. Employment is generally the most important means of obtaining adequate economic resources, which are essential for material well-being and full participation in today’s society;. Work meets important psychosocial needs in societies where employment is the norm;. Work is central to individual identity, social roles and social status;. Employment and socio-economic status are the main drivers of social gradients in physical and mental health and mortality;. Various physical and psychosocial aspects of work can also be hazards and pose a risk to health. Unemployment: Conversely, there is a strong association between worklessness and poor health. This may be partly a health selection effect, but it is also to a large extent cause and effect. There is strong evidence that unemployment is generally harmful to health, including:. higher mortality;. poorer general health, long-standing illness, limiting longstanding illness;. poorer mental health, psychological distress, minor psychological/psychiatric morbidity;. higher medical consultation, medication consumption and hospital admission rates. Re-employment: There is strong evidence that reemployment leads to improved self-esteem, improved general and mental health, and reduced psychological distress and minor psychiatric morbidity. The magnitude of this improvement is more or less comparable to the adverse effects of job loss. Work for sick and disabled people: There is a broad consensus across multiple disciplines, disability groups, employers, unions, insurers and all political parties, based on extensive clinical experience and on principles of fairness and social justice. When their health condition permits, sick and disabled people (particularly those with ‘common health problems’) should be encouraged and supported to remain in or to (re)-enter work as soon as possible because it:. is therapeutic;. helps to promote recovery and rehabilitation;. leads to better health outcomes;. minimises the harmful physical, mental and social effects of long-term sickness absence;. reduces the risk of long-term incapacity;. promotes full participation in society, independence and human rights;. reduces poverty;. improves quality of life and well-being. Health after moving off social security benefits: Claimant who move off benefits and (re)-enter work generally experience improvements in income, socio-economic status, mental and general health, and well-being. Those who move off benefits but do not enter work are more likely to report deterioration in health and well-being. Provisos: Although the balance of the evidence is that work is generally good for health and well-being, for most people, there are three major provisos:. These findings are about group effects; a minority of people (possibly 5–10%) may experience contrary health effects from work(lessness);. Beneficial health effects depend on the nature and quality of work (though there is insufficient evidence to define the physical and psychosocial characteristics of jobs and workplaces that are ‘good’ for health);. The relationship between work(lessness) and health must take account of the social context, particularly of social gradients in health and regional deprivation. Conclusion: There is a strong evidence base showing that work is generally good for physical and mental health and well-being. Worklessness is associated with poorer physical and mental health and well-being. Work can be therapeutic and can reverse the adverse health effects of unemployment. That is true for healthy people of working age, for many disabled people, for most people with common health problems and for social security beneficiaries. The provisos are that account must be taken of the nature and quality of work and its social context; jobs should be safe and accommodating. Overall, the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long-term unemployment or prolonged sickness absence. Work is generally good for health and well-being

Aims. COVID-19-related patient care delays have resulted in an unprecedented patient care backlog in the field of orthopaedics. The objective of this study is to examine orthopaedic provider preferences regarding the patient care backlog and financial recovery initiatives in response to the COVID-19 pandemic. Methods. An orthopaedic research consortium at a multi-hospital tertiary care academic medical system developed a three-part survey examining provider perspectives on strategies to expand orthopaedic patient care and financial recovery. Section 1 asked for preferences regarding extending clinic hours, section 2 assessed surgeon opinions on expanding surgical opportunities, and section 3 questioned preferred strategies for departmental financial recovery. The survey was sent to the institution’s surgical and nonoperative orthopaedic providers. Results. In all, 73 of 75 operative (n = 55) and nonoperative (n = 18) providers responded to the survey. A total of 92% of orthopaedic providers (n = 67) were willing to extend clinic hours. Most providers preferred extending clinic schedule until 6pm on weekdays. When asked about extending surgical block hours, 96% of the surgeons (n = 53) were willing to extend operating room (OR) block times. Most surgeons preferred block times to be extended until 7pm (63.6%, n = 35). A majority of surgeons (53%, n = 29) believe that over 50% of their surgical cases could be performed at an ambulatory surgery centre (ASC). Of the strategies to address departmental financial deficits, 85% of providers (n = 72) were willing to work extra hours without a pay cut. Conclusion. Most orthopaedic providers are willing to help with patient care backlogs and revenue recovery by working extended hours instead of having their pay reduced. These findings provide insights that can be incorporated into COVID-19 recovery strategies. Level of Evidence: III. Cite this article: Bone Jt Open 2021;2(7):562–568

Successful return to work (RTW) is a crucial outcome after primary total knee arthroplasty (TKA) in patients under 65 years old. We aimed to determine whether TKA facilitated RTW in patients <65 years, whose intention was to return preoperatively. We prospectively assessed 106 TKA patients under 65 years over a 1 year period both preoperatively and at 1 year following surgery. Patient demographics were collected including Oxford knee score, Oxford-APQ, VAS pain/health scores and EQ-5D. A novel questionnaire was distributed to delineate pre-operative employment status and post-operative intentions. This included questions on nature of pre and post-operative occupation, whether joint disease affected their ability to work and details of retirement plans and how this was affected by their knee. 69 patients intended to return to work following their TKA. Following arthroplasty, 57/69 patients (82.6%) returned to work at a mean of 16.4 weeks (SD 16.6). Univariate analysis showed significant factors facilitating RTW included, pre-operative oxford knee score, pre-operative Oxford-APQ score and pre-operative EQ-5D score. These were not predictive on multivariate analysis. This study finds that TKA facilitates return to work in 83% of those who intend to return to work following their surgery. This could have significant positive and health and financial cost implications for the individual, health system and society

Purposes and Background. Musculoskeletal disorders including as back and neck pain are leading causes of work disability. Effective interventions exist (i.e. functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool developed using machine learning to help select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample. Our purpose was to externally validate the WATT. Methods and Results. A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial compensation database. Data were available on workers being considered for rehabilitation between January 2013 and December 2016. Data was obtained on patient characteristics (ie. age, sex, education level), clinical factors (ie. diagnosis, part of body affected, pain and disability ratings), occupational factors (ie. occupation, employment status, modified work availability), type of rehabilitation program undertaken, and return-to-work outcomes (receipt of wage replacement benefits 30 days after assessment). Analysis included classification accuracy statistics of WATT recommendations for selecting interventions that lead to successful RTW outcomes. The sample included 5296 workers of which 33% had spinal conditions. Sensitivity of the WATT was 0.35 while specificity was 0.83. Overall accuracy was 73%. Conclusion. Accuracy of the WATT for selecting successful rehabilitation programs was modest. Algorithm revision and further validation is needed. No conflicts of interest. Sources of funding: Funding was provided by the Workers' Compensation Board of Alberta

Introduction. We used patient reported outcome measures (PROMS) to evaluate qualitative and societal outcomes of trauma. Methods. We collected PROMs data between Sept 2013 and March 2015 for 92 patients with injury severity score (ISS) greater than 9. We enquired regarding return to work, income and socioeconomic status, dignity and satisfaction and the EQ-5D questionnaire. Results. Return to work. Of patients working at admission 15/58(26%) anticipated returning to work within 14 days of discharge. Work plans at discharge did not correlate with ISS scores overall (r=−0.05, ns), or when stratified by working group. Increased physicality of work showed a trend towards poorer return to work outcomes (not significant in Spearman's rank analysis: r= 0.14, p= 0.32). Income and socioeconomic status: No significant difference was demonstrated between the comparative incomes of patients with the best and worst return to work outcomes (ANOVA n=61, t=0.63, ns). Lowest quartile earners (n=19) were more likely to complete the open questions (79%) than higher income patients (62%). Dignity and satisfaction: Prominent positive themes were: care, staff, professionalism, and communication. Prominent negative themes were: food, ward response time, and communication. %). Patients ‘mostly’ or ‘always’ satisfied with their care did not have significantly different incomes (ANOVA, t=0.13, ns). EQ-5D: Self-rated health status correlated with perceived likelihood of return to work (r=0.25, p=0.0395). Correlation was demonstrated between EQ-5D scores and perceived dignity preservation (r=0.38, p=0.0004), and overall satisfaction (r=0.46, p< 0.0001). There was no correlation between EQ-5D and ISS score. Conclusion. EQ5D correlated with work plans, dignity, and satisfaction. Planned return to work did not correlate with ISS score or socioeconomic status. Unlike previous studies we demonstrated that lower socioeconomic groups have best engagement with PROMS. This study highlighted the value of qualitative PROMS analysis in leading patient-driven improvements in trauma care

We present a retrospective study of a consecutive cohort of 109 patients, under the age of 60, who had either a patello-femoral replacement (PFR), uni-compartmental replacement (UKR) or a total knee replacement (TKR). They were operated on by 2 senior surgeons between 2002 and 2006 at the Avon Orthopaedic Centre in Bristol. The aim of this study was to look at the effect of knee replacement on the employment status of this group of patients. Data were collected from patient’s hospital records and a questionnaire regarding occupational status sent postoperatively to patients. Statistical analysis showed that our groups were similar which meant that further comparison between them was valid. Eighty two percent of patients who were working prior to surgery and who had either a TKR or UKR were able to return to work postoperatively. Only 54% of those who had a PFR were able to return to work and this was statistically significant when compared with patients in the other two groups p=0.047. The median time for return to work postoperatively for the study population was 12 weeks. Those in the PFR group took significantly longer to do so (20 weeks) compared to those who had either a UKR (11 weeks) or TKR (12 weeks) p=0.01. Patient’s subjective opinion as to their ability to work following knee arthroplasty was worse in the PFR group p=0.049. This is the first study to compare employment status following patello-femoral, uni-compartmental knee and Total Knee Replacement. TKR and UKR are effective in returning patients to active employment and that this is typically 3 months following surgery. Patients who had a PFR did not experience the same benefits in terms of numbers returning to work, time to do so and their subjective opinion as to their ability to cope with normal duties

Background. Both anatomic (TSA) and reverse shoulder arthroplasty (RSA) are routinely performed for patients whom desire to continue to work or participate in sports. The purpose of this study is to analyze and compare the ability of patients to work and participate in sports based on responses to clinical outcome surveys. Methods. A retrospective review of 335 patients treated with TSA (179 patients) and RSA (156 patients) who completed questions 9 and 10 on the activity patient self-evaluation portion of the American Shoulder and Elbow Surgeons (ASES) Assessment Form was performed at average 30 months follow-up. Comparisons were made between TSA and RSA for the specific ASES score (rated 0–3) reported for usual work and sport, as well as ASES total score. Sports were subdivided based on those that predominantly use shoulder function. Results. Patients treated with TSA had a 32% greater ability to participate in sports (average specific ASES score 2.5 vs 1.9, p=0.001), with significantly higher scores for aquatic and sedentary sports (Figure 1). TSA patients demonstrated greater ability to participate in sports requiring shoulder function without difficulty, as 62% reported maximal scores (p=0.001) (Figure 2). TSA patients also demonstrated a 21% greater ability to perform work (average specific ASES score 2.6 vs. 2.1, p=0.001), with significantly higher scores for housework and gardening (Figure 3). Conclusion. Both TSA and RSA allow for participation in work and sport, with TSA patients reporting better overall ability to participate. For sports involving shoulder function, TSA patients more commonly report maximal ability to participate than RSA patients

Introduction:. The aim of this study was to assess patients reported fitness to return to work and to driving after ankle replacement. Method:. Using Hospital Joint Registry, patients who underwent ankle replacement between 2006 and 2011 were invited to take part in the study. Questionnaires were sent to these patients. Participants were asked to report the nature and pattern of their work (full time or part time), time it took to return to work and subsequent nature of work. Participants were also asked about time to return to driving. Results:. 173 participants were given eight weeks to reply. In this time there were 131 responses (response rate 76%). There were 79 male and 52 female respondents. Of the responses 61% (n=80) were retired, 24% (n=42) were employed, 5% (n=9) were unemployed before the surgery. Of those who were employed prior to ankle replacement, 29 respondents reported working full time and 11 respondents were working part time and 5 were self employed. 10 (24%) patients returned to work at 6 weeks 22 (52%) were able to work by 3 months. Following surgery 5 of the patients did not return to work off which one took retirement. 45 (40%) respondents could drive at 6 weeks, 34 (22%) at 3 months and 11 by 6 months. 20 (12%) patients did not drive before surgery. There were 23 responses about nature of employment, 10 being manual workers and 13 being office workers. Of the manual workers 5 patients returned to full time work. Conclusion:. We conclude from this study that the 76% of the employed patients prior to their ankle replacement were able to return to work by 6 months with 24 % returning by 6 weeks. 71% were able to drive at 3 months after surgery

We performed a retrospective study of a consecutive cohort of 109 patients, under the age of 60 years, who had either a Patellofemoral replacement (PFR), Uni-compartmental replacement (UKR) or a Total knee replacement (TKR). They were operated on by 2 senior surgeons between 2002 and 2006 at the Avon Orthopaedic Centre in Bristol. The aim of this study was to examine and compare the effect of knee replacement on the employment status of this group of patients. Demographic and diagnostic data were collected from patient’s hospital records and a detailed questionnaire regarding occupational status sent postoperatively. Of the 109 patients, 37 underwent PFR, 31 UKR and 41 TKR. The study population included 38 men and 71 women and the mean age for both sexes was 53 years (range 40–60 years). 82% of patients who were working prior to surgery and who had either a TKR or UKR were able to return to work postoperatively. Only 54% of those who had a PFR were able to return to work and this was statistically significant when compared with patients in the other two groups p=0.47. The median time for return to work postoperatively for the study population was 12 months. Those in the PFR group took significantly longer to do so (20 months) compared to those who had either a UKR (11 months) or TKR (12 months) p=0.01. Patient’s subjective opinion as to their ability to work following knee arthroplasty was worse in the PFR group p=0.049. This is the first study to compare employment status following Patellofemoral, Unicompartmental knee and Total Knee Replacement. TKR and UKR are effective in returning patients to active employment and this is typically one year following operation. Those patients who had a PFR did not experience the same benefits in terms of numbers returning to work, time to do so and their subjective opinion as to their ability to cope with normal duties

Introduction. Cubital Tunnel syndrome is common affecting 1 in 4000 people. The cubital tunnel serves as major constraint for the ulna nerve. Cubital tunnel decompression is a relatively simple operation to resolve the patients' symptoms. There has been published data on return to work and normal activity after carpal tunnel decompression but not cubital tunnel. Method. All patients who underwent cubital tunnel decompression in Wirral University Teaching Hospital NHS Foundation Trust between September 2006 and September 2010 were identified and sent a questionnaire; enquiring about age, type of job & if it involved heavy lifting, time off work, range of movement at elbow and hand and if their symptoms resolved or if they had any other complications. Results. 106 cubital tunnels were decompressed in the 4 year period. 66 patients returned the questionnaire (62% response). The average age at operation was 59 years (32–86years). The average time to return to work after surgery was 10 days (0–300days). Complications included painful scar, return of symptoms and chronic region pain syndrome, which lead the patient to change jobs (300days). Only one patient was self-employed, they had no time off work. In 24 patients (36%) their symptoms either never resolved or returned, only worsening in 2 patientsstopping them returning to work their heavy manual jobs. The DASH score (work modules) post operatively was 38.3 over all working groups; this was lower in patients who didn't have a manual job. Conclusion. Our patients, returned to work at around 10 days after surgery. People with jobs which involved no heavy lifting returned at 5 days compared to that of 40 days, in patients with manual jobs. Now we can give our patients more accurate information about how long it will take them to return to work, depending on their job type

This study investigated the time lost from work following a distal radius fracture and its predictors. A cohort of one hundred and sixty-eight workers who experienced a distal radius fracture were followed at two, three, six, and twelve months to determine their work status. The average number of weeks lost from work was 9.5 weeks. Significant correlates with lost-time from work were: energy of injury, occupational demand, workers compensation, initial radial inclination on x-ray, baseline PRWE and DASH scores and Mental Component-SF-36). Without self-report, 45% of the variation in lost-time was explained by workers compensation status, radial inclination, occupational demand, energy of injury, sex and age. This study investigated the time lost from work following a distal radius fracture and its predictors. Time lost from work after a distal radius fracture is highly variable. Patients who have higher job demands (hand use), are on workers compensation, report higher initial pain/disability and who present with more severe displacement have the highest lost-time. This data defines average expectations of return to work and the extent to which injury, job and personal characteristics influence it. The average number of weeks lost from work was 9.5 weeks ( median= 6; 75th percentile=12 SD=9.6; range = 0–44). Significant correlates with lost-time from work were: energy of injury, occupational demand, workers compensation, initial radial inclination on x-ray, baseline PRWE and DASH scores and Mental Component-SF-36). A stepwise multiple linear regression found that 50% of the variation in lost-time could be explained on the basis of the initial PRWE, occupational demand and radial inclination. Without self-report, 45% of the variation in lost-time was explained by workers compensation status, radial inclination, occupational demand, energy of injury, sex and age. A cohort of one hundred and sixty-eight workers who experienced a distal radius fracture were enrolled. Age, sex, education level, smoking status, alcohol consumption, injury compensation status, occupational use of hand, energy of injury and radiographic injury severity (pre-reduction radial shortening, radial inclination, dorsal angulation) were recorded. Patients were followed at two, three, six, and twelve months to determine their work status. Multiple linear regression identified predictors of time lost from work