Association between body mass index and return to work following primary knee arthroplasty: a population-based cohort study on 6,128 patients from Danish national registers
DOI:
https://doi.org/10.2340/17453674.2025.44253Keywords:
Arthroplasty, Knee, OsteoarthrosisAbstract
Background and purpose: With more knee arthroplasties (KAs) performed in working-age patients, interest in return to work (RTW) increases. We aimed to investigate the association between body mass index (BMI) and RTW after primary KA and whether the association varies by sex, age, comorbidity, and socioeconomic position.
Methods: From Danish national registries, we included 6,128 patients aged 18 to 60 years undergoing KA from 2008–2018. Exposure was BMI in categories < 25.0, 25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥ 40.0. Outcome was RTW after KA. We estimated cumulative incidence proportions (CIP) of RTW. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI).
Results: Median time to RTW was 70 days. Overall CIP for RTW was 63% (CI 62–65) at 3 months. With BMI < 25 as reference, CIP was 65% (n = 1,401) for BMI 25.0–29.9, 64% (n = 1,130) for BMI 30.0–34.9, 60% (n = 528) for BMI 35.0–39.9, and 60% (n = 260) for BMI ≥ 40.0, corresponding to an adjusted HR of 1.06 (CI 0.98–1.15), 1.02 (CI 0.94–1.11), 0.97 (CI 0.88–1.06), and 0.96 (CI 0.85–1.08). Men with BMI 35.0–39.9 and ≥ 40 had an adjusted HR of 0.89 (CI 0.76–1.05) and 0.87 (CI 0.70–1.10). None of the associations were statistically significant. Age, comorbidity, and socioeconomic position did not modify the association between BMI and RTW.
Conclusion: More than 60% of patients RTW within 3 months but we found no association between BMI and RTW after primary KA.
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Kurtz S M, Lau E, Ong K, Zhao K, Kelly M, Bozic K J. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop 2009; 467(10): 2606-12. doi: 10.1007/s11999-009-0834-6. DOI: https://doi.org/10.1007/s11999-009-0834-6
Steinmetz J D, Culbreth G T, Haile L M, Rafferty Q, Lo J, Fukutaki K G, et al. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol 2023; 5(9): e508-22. doi: 10.1016/S2665-9913(23)00163-7. DOI: https://doi.org/10.1016/S2665-9913(23)00163-7
Pasqualini I, Emara A K, Rullan P J, Pan X, Simmons H L, Molloy R M, et al. Return to sports and return to work after total knee arthroplasty: a systematic review and meta-analysis. JBJS Rev 2023; 11(7). doi: 10.2106/JBJS.RVW.22.00250. DOI: https://doi.org/10.2106/JBJS.RVW.22.00250
Tilbury C, Schaasberg W, Plevier J W M, Fiocco M, Nelissen R G H H, Vliet Vlieland T P M. Return to work after total hip and knee arthroplasty: a systematic review. Rheumatol Oxf Engl 2014; 53(3): 512-25. doi: 10.1093/rheumatology/ket389. DOI: https://doi.org/10.1093/rheumatology/ket389
Kamp T, Brouwer S, Seeber G H, Overgaard S, Gademan M G J, Stevens M. Return to work policies and practices after total hip or knee arthroplasty in Denmark, Germany, and the Netherlands: an exploratory study. Disabil Rehabil 2024; 1-10. doi: 10.1080/09638288.2024.2304084. DOI: https://doi.org/10.1080/09638288.2024.2304084
Kaila-Kangas L, Leino-Arjas P, Koskinen A, Takala E P, Oksanen T, Ervasti J, et al. Sickness absence and return to work among employees with knee osteoarthritis with and without total knee arthroplasty: a prospective register linkage study among Finnish public sector employees. Scand J Work Env Health 2021; 47(8): 600-8. doi: 10.5271/sjweh.3989. DOI: https://doi.org/10.5271/sjweh.3989
Van Leemput D, Neirynck J, Berger P, Vandenneucker H. Return to work after primary total knee arthroplasty under the age of 65 years: a systematic review. J Knee Surg 2022; 35(11): 1249-59. doi: 10.1055/s-0040-1722626. DOI: https://doi.org/10.1055/s-0040-1722626
Danish Knee Arthroplasty Register [Internet]. Report No.: Annual report 2022. Available from: https://www.sundhed.dk/content/cms/99/4699_dkr-aarsrapport-2022_udgivet2023_offentliggjort_version.pdf
Pedersen A, Mehnert, Odgaard A, Schrøder H M. Existing data sources for clinical epidemiology: the Danish Knee Arthroplasty Register. Clin Epidemiol 2012 May; 125. doi: 10.2147/CLEP.S30050. DOI: https://doi.org/10.2147/CLEP.S30050
Jensen C B, Petersen P B, Jørgensen C C, Kehlet H, Troelsen A, Gromov K, et al. Length of stay and 90-day readmission/complication rates in unicompartmental versus total knee arthroplasty: a propensity-score-matched study of 10,494 procedures performed in a fast-track setup. J Bone Joint Surg 2021; 103(12): 1063. doi: 10.2106/JBJS.20.01287. DOI: https://doi.org/10.2106/JBJS.20.01287
Liljensøe A, Lauersen J O, Søballe K, Mechlenburg I. Overweight preoperatively impairs clinical outcome after knee arthroplasty: a cohort study of 197 patients 3–5 years after surgery. Acta Orthop 2013; 84(4): 392-7. doi: 10.3109/17453674.2013.799419. DOI: https://doi.org/10.3109/17453674.2013.799419
Schramm S, Sørensen T I A, Davidsen M, Tolstrup J S. Changes in adult obesity prevalence in Denmark, 1987–2021: age-period-cohort analysis of nationally representative data. Eur J Public Health 2023; 33(3): 463-7. doi: 10.1093/eurpub/ckad024. DOI: https://doi.org/10.1093/eurpub/ckad024
Hjollund N H, Larsen F B, Andersen J H. Register-based follow-up of social benefits and other transfer payments: accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey. Scand J Public Health 2007; 35(5): 497-502. doi: 10.1080/14034940701271882. DOI: https://doi.org/10.1080/14034940701271882
Laugesen K, Ludvigsson J F, Schmidt M, Gissler M, Valdimarsdottir U A, Lunde A, et al. Nordic Health Registry-Based Research: a review of health care systems and key registries. Clin Epidemiol 2021; 13: 533-54. doi: 10.2147/CLEP.S314959. DOI: https://doi.org/10.2147/CLEP.S314959
Kugelman D N, Wu K A, Goel R K, Dilbone E S, Ryan S P, Bolognesi M P, et al. Comparing functional recovery between total and unicompartmental knee arthroplasty: a prospective health kit study. J Arthroplasty 2025; S0883-5403(25)00298-0. doi: 10.1016/j.arth.2025.03.061. DOI: https://doi.org/10.1016/j.arth.2025.03.061
ICD-11 for Mortality and Morbidity Statistics (Version : 01/2023) [Internet]. Available from: https://icd.who.int/browse11/l-m/en
Lauridsen M D, Rørth R, Butt J H, Schmidt M, Weeke P E, Kristensen S L, et al. Return to work after acute myocardial infarction with cardiogenic shock: a Danish nationwide cohort study. Eur Heart J Acute Cardiovasc Care 2022; 11(5): 397-406. doi: 10.1093/ehjacc/zuac040. DOI: https://doi.org/10.1093/ehjacc/zuac040
Laut K G, Hjort J, Engstrøm T, Jensen L O, Tilsted Hansen H H, Jensen J S, et al. Impact of health care system delay in patients with ST-elevation myocardial infarction on return to labor market and work retirement. Am J Cardiol 2014; 114(12): 1810-16. doi: 10.1016/j.amjcard.2014.09.018. DOI: https://doi.org/10.1016/j.amjcard.2014.09.018
Jørgensen H, Horváth-Puhó E, Laugesen K, Braekkan S, Hansen J B, Sørensen H T. Socioeconomic status and risk of incident venous thromboembolism. J Thromb Haemost JTH 2021; 19(12): 3051-61. doi: 10.1111/jth.15523. DOI: https://doi.org/10.1111/jth.15523
Kuijer P P, Kievit A J, Pahlplatz T M, Hooiveld T, Hoozemans M J, Blankevoort L, et al. Which patients do not return to work after total knee arthroplasty? Rheumatol Int 2016; 36(9): 1249-54. doi: 10.1007/s00296-016-3512-5. DOI: https://doi.org/10.1007/s00296-016-3512-5
Lankinen P, Laasik R, Kivimäki M, Aalto V, Saltychev M, Vahtera J, et al. Are patient-related pre-operative factors influencing return to work after total knee arthroplasty. Knee 2019; 26(4): 853-60. doi: 10.1016/j.knee.2019.04.015. DOI: https://doi.org/10.1016/j.knee.2019.04.015
Sankar A, Davis A M, Palaganas M P, Beaton D E, Badley E M, Gignac M A. Return to work and workplace activity limitations following total hip or knee replacement. Osteoarthritis Cartilage 2013; 21(10): 1485-93. doi: 10.1016/j.joca.2013.06.005. DOI: https://doi.org/10.1016/j.joca.2013.06.005
Styron J F, Barsoum W K, Smyth K A, Singer M E. Preoperative predictors of returning to work following primary total knee arthroplasty. J Bone Joint Surg Am 2011; 93(1): 2-10. doi: 10.2106/JBJS.I.01317. DOI: https://doi.org/10.2106/JBJS.I.01317
Kamp T, Gademan M G J, van Zon S K R, Nelissen R, Vliet Vlieland T P M, Stevens M, et al. Time to return to work by occupational class after total hip or knee arthroplasty. Bone Joint J 2023; 105-B(9): 977-84. doi: 10.1302/0301-620X.105B9.BJJ-2023-0190.R1. DOI: https://doi.org/10.1302/0301-620X.105B9.BJJ-2023-0190.R1
Kamp T, Brouwer S, Hylkema T H, van Beveren J, Rijk P C, Brouwer R W, et al. Psychosocial working conditions play an important role in the return-to-work process after total knee and hip arthroplasty. J Occup Rehabil 2022; 32(2): 295-305. doi: 10.1007/s10926-021-10006-7. DOI: https://doi.org/10.1007/s10926-021-10006-7
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Copyright (c) 2025 Julie B Pajaniaye, Peter Alsing, Martin G Stisen, Erzsébet Horváth-Puhó, Maaike G J Gademan, Alma B Pedersen, Inger MECHLENBURG Mechlenburg
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