Introduction People are increasingly encouraged to work to older ages, thus returning to and staying in work is an important outcome for younger arthroplasty recipients.

Objectives We examined the impact of physically-demanding occupational activities on the risk of leaving a job because of difficulties with the replaced hip.

Methods A survey was mailed to 1,457 unilateral THA recipients of working age (18–64 years) from the Geneva Hip Arthroplasty Registry and the Clinical Outcomes in Arthroplasty study. People were eligible if they had received their arthroplasty 5 years before. We collected demographic data, time to reach best function and post-operative recreational activities. For each job held post-operatively, participants self-reported exposure to activities that loaded the joint (standing, walking, kneeling/squatting, climbing ladders, lifting, digging). The risk of job loss in relation to occupational activities was calculated using Cox regression models adjusting for age at operation, sex, body mass index, time to reach best post-operative function, cohort and follow-up.

Results In total 514 of 817 respondents (57% response rate) resumed work post-arthroplasty. Amongst these (206 men and 205 women), 411 self-reported usable occupational information. The median follow-up post-THA was 7.5 years (IQR 6.2 -12.1). Adjusted models showed that there was an increased risk of exiting work post-arthroplasty because of problems with the replaced hip were increased if workers were exposed to: standing>4 hours/day (HR:3.81, 95%CI 1.62–8.96); kneeling/squatting (HR:95%CI 3.32, 1.46–7.55) and carrying/lifting>10 kg (HR:5.43, 95%CI 2.29–12.88) compared with those who did not.

Conclusion Certain types of occupational activities may hamper job retention following THA. Our results, although subject to replication, suggest that some types of more physically-demanding work may be more challenging to continue post-hip arthroplasty. There may be a role for focussed rehabilitation or career advice or re-deployment of people in some types of jobs.