O29 Returning to, and staying in, work after total hip arthroplasty
Authors: Zaballa Elena , Harris E. Clare , Lübbeke-Wolff Anne , Cooper Cyrus , Arden Nigel , Ntani Georgia , Walker-Bone Karen 
Published: April 2021

Abstract
Background/Aims
Total hip arthroplasty is increasingly offered at younger ages whilst simultaneously people are being encouraged to work to older ages. Ultimately, more people will expect to need to return to work post-THA. We explored the rates of return to work and the trajectories of remaining in work post-THA, with particular attention to the physical demands of the post-operative job.
Methods
Patients from the Geneva Hip Arthroplasty Registry and the Clinical Outcomes of Arthroplasty (COASt) study who underwent unilateral THA at least 5 years previously were identified. Participants were eligible if they were &lt;65 years old at the time of the THA. A postal questionnaire was mailed to all eligible participants 2017-2019. Information was collected about demographics, relevant pre-operative and peri-operative factors, time to reach best function and leisure-time physical activities performed post-operation. For each job held post-operatively, participants provided information about the nature of physically-demanding exposures. Crude and adjusted estimates with their corresponding 95% confidence intervals (CI) were calculated using Cox proportional hazard models to estimate associations between occupational activities and risk of leaving a job due to difficulties with the replaced hip. Finally, mutually adjusted models were fitted with all the relevant covariates and the statistically significant occupational activities.
Results
Of the 1,453 eligible people, 817 (56%) returned the questionnaire. Post-operation 508 people returned to work (RTW) of whom: 446 were working at the time of the THA; 46 had stopped working pre-operatively; and 16 did not provide pre-operative work status. The median follow-up post-THA was 7.5 years (IQR 6.2 -12.1). Detailed occupational exposure information was available for 405 of the 508 who returned to work (203 men and 202 women). After adjusting for age at operation, sex, body mass index, time to reach best post-operative function, cohort and age at follow-up, reporting leaving a job because of problems with the replaced hip was strongly associated with: occupational standing &gt; 4 hours/day (HR: 3.37, 95%CI 1.44-7.86), kneeling/squatting (HR: 95%CI 3.67, 1.61-8.40) and carrying/lifting&gt; 10 kg (HR: 5.68, 95%CI 2.37-13.62) . Mutually adjusted models showed that the effect of lifting/carrying weights in excess of 10 kg remained statistically significant (p &lt; 0.01).
Conclusion
These findings suggest that some jobs may be more difficult to manage post-THA, in particular if they involve prolonged standing, kneeling/squatting or lifting heavy weights. Subject to replication in other cohorts, these findings may be important to discuss with patients at the time of surgery and could imply a particular role for post-THA rehabilitation amongst people needing to RTW in physically-demanding jobs.
Disclosure
E. Zaballa: None. E. Harris: None. A. Lübbeke-Wolff: None. C. Cooper: None. N. Arden: None. G. Ntani: None. K. Walker-Bone: None.