Introduction There is limited evidence on the ability to sustain employment following knee replacement.

Objective To describe occupational status before and after uni-compartmental (UKR) and total knee replacement (TKR) and to explore work ability after both types of knee arthroplasty.

Methods This study was set within the longitudinal Clinical Outcomes in Arthroplasty study. Eligible participants were those who were aged 18–64 years at the time of their primary arthroplasty and had at least 5 years’ duration follow-up since. All eligible participants were mailed a questionnaire which enquired about: pre- and post-operative occupations and occupational exposures; time to reach best function; and leisure-time physical activities performed post-operation. We used Cox regression to estimate crude and adjusted hazard ratios with 95% confidence intervals to explore the role of work factors in determining post-operative work ability (CI).

Results 251 useable responses were received (61% response) amongst whom 158 (63%) returned to any work post-operatively. Most of these, 146 (92%) had been working pre-operatively. Detailed occupational exposure information was available for 145 (94 UKRs, 51 TKRs) of the 158 who RTW. The mean follow-up post-operation was 6.4 years (SD±1). Adjusted models showed that workers were at increased risk of leaving their job post-operation if an average working day involved: lifting/carrying ≥10 kg (HR: 4.57 95%CI 1.52,13.79) or climbing 30 flights of stairs/day (HR:3.52 95%CI 1.29,9.59), as compared with workers not doing these activities. Mutually adjusted models showed that it was the lifting/carrying weights in excess of 10 kg that was most important (HR:3.6 95%CI 1.1,11.3).

Conclusion Many people effectively return to work post knee-replacement. However, job retention is poorer in occupations that entail lifting weights and climbing flights of stairs. Subject to replication, these findings could imply a particular role for post-UKR/TKR rehabilitation amongst people needing to RTW in physically-demanding jobs.