Total hip and knee replacement and return to work: clinicians’ perspectives

Abstract

Purpose

An ageing workforce means that our understanding of return to work following total hip and knee replacement is of increasing importance. The purpose of this qualitative study was to explore the views and experiences of clinicians in treating working patients undergoing total hip or knee replacement.

Materials and methods

We conducted semi-structured interviews in primary and secondary National Health Service care using framework methodology. A total of 40 interviews were conducted. Participants included 12 hospital-based Allied Health Professionals and nurses, 12 orthopedic surgeons, and 16 General Practitioners. Data were analyzed thematically.

Results

A key theme concerned participants' perceptions and experiences around the process and practice of listing working patients for total hip or knee replacement. Four sub-themes were identified; the perceived likelihood of listing employed patients for surgery, expectations and outcomes of surgery, the impact of work issues, and referral procedures and waiting lists.

Conclusions

Decisions around listing working patients for total hip and knee replacement are complex and difficult. Clinicians need to consistently consider patients’ work issues, and to be supported in this by appropriate commissioning and service delivery decisions. Further research is indicated to better understand the work-related expectations and anticipated outcomes of both patients and clinicians, and the optimum timing of surgery to maintain and improve patients’ work performance.

Implications for rehabilitation

• Clinicians need to consistently consider patients’ work issues, and current evidence, in their consultations and decisions regarding total hip and knee replacement.

• Clinical practice should reflect the growing proportion of working patients undergoing total hip and knee replacement, and routinely measure work outcomes.

• Changes are required at commissioning and service levels to support clinicians in changing their practice with this patient population.

Keywords:

• Return to work
• total hip replacement
• total knee replacement
• framework
• qualitative
• interviews
• clinicians

Acknowledgments

The authors would like to acknowledge the study participants. The authors are grateful also to all the members of the wider OPAL study group including Judith Fitch, Catherine Hewitt, Sayeed Khan, Catriona McDaid, David McDonald, Iain McNamara, Amar Rangan, Gerry Richardson and Louise Thomson; and to Jennifer Geraghty for assistance in writing up the interview themes. The OPAL investigators acknowledge the support of the British Orthopedic Association Orthopedic Surgery Research Center (BOSRC) which supports the development of orthopedic surgical trials.

Ethical approval

The study was approved by the NHS Health Research Authority on 4 October 2016 (Research Ethics Committee reference 16/EM/0341). All participants received information about the study and participation was voluntary. All participants provided written or verbal consent. Results are presented on a group level and quotations are anonymous to avoid identification of any individual participant.

Disclosure statement

The authors declare that they have no competing interests.

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Additional information

Funding

This project was funded by the National Institute for Health Research Health Technology Assessment (HTA) program (project number 15/28/02). The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Further information available at: https://fundingawards.nihr.ac.uk/award/15/28/02.