Do socio-professional categories influence the time to return to work after a primary hip replacement? Insights from a prospective study at a French center.

Abstract

Background: The factors influencing return to work (RTW) after primary total hip arthroplasty (THA) remain a topic of debate. Understanding these factors is essential for optimizing postoperative recovery and patient counseling. This study aims to determine whether socio-professional status and clinical factors significantly influence the timing of RTW following elective hip replacement. The study addresses the following questions: (1) Does socio-professional status impact the timing of RTW after THA? (2) What clinical factors are associated with delayed RTW? (3) What is the typical length of sick leave for professionally active patients after THA?

Hypothesis: We hypothesize that socio-professional status and specific clinical factors, such as Body Mass Index (BMI) and postoperative complaints, significantly influence the timing of RTW after hip replacement.

Methods: A prospective cohort study was conducted, including 171 professionally active patients aged 18-65 years who underwent primary THA at an arthroplasty center in France between February 2020 and March 2021. Preoperative data on socio-professional status, job position, and clinical characteristics were collected. Occupations were categorized into six socio-professional groups based on physical demands. RTW status was assessed at 3 and 4 months postoperatively. Statistical analysis involved univariate and multivariate logistic regression to identify factors influencing RTW.

Results: Among the 171 patients (85 males, 86 females), the median age was 58 years (IQR: 53-61), and the median BMI was 25 kg/m² (IQR: 22-28) (24 (14%) patients had BMI >30 kg/m²). At the three-month follow-up, 136 patients (80%) had returned to work, with a median RTW time of 63 days (IQR: 58-76). The remaining 35 patients required an extended sick leave of 33 days (IQR: 8-42), with an overall median sick leave duration of 66 days (IQR: 60-90). Univariate analysis identified factors significantly associated with delayed RTW, including being an employee (OR = 2.386, 95% CI: 1.067-5.334 (p = 0.034)), higher BMI (OR = 1.114, 95% CI: 1.019-1.218 (p = 0.017)), and persistent postoperative complaints (OR = 4.476, 95% CI: 1.796-11.158 (p = 0.001)). Multivariate analysis confirmed that higher BMI (OR = 1.108, 95% CI: 1.004-1.223 (p = 0.041)) and persistent postoperative complaints (OR = 8.820, 95% CI: 3.172-24.529 (p < 0.001)) remained significant independent predictors of delayed RTW.

Conclusion: Higher BMI and persistent postoperative complaints are the primary factors delaying return after total hip replacement, while socio-professional status shows a less significant impact when other factors are considered. These findings highlight the importance of addressing modifiable risk factors to facilitate a timely RTW and optimize patient outcomes.

Level of evidence: IV; prospective study.