Coordinated Return-to-Work Model Reduces Sick Leave After Hip/Knee Arthroplasty

Overview

This registry study evaluated the effectiveness of a Coordinated Return-to-Work (CRTW) model in reducing sick leave duration after total hip or knee arthroplasty among working-age patients eligible for occupational health services (OHS) in Finland. Results demonstrated that the CRTW model, which integrates surgical care with OHS support, significantly decreased time to return to work (RTW) compared to usual care.

Background

Osteoarthritis leads to increasing numbers of total hip and knee arthroplasties, many performed on working-age individuals. While fast-track surgical protocols improve hospital outcomes, long-term recovery and work ability remain critical concerns. In Finland, although most employees have access to OHS, post-surgical occupational health consultations have been rare. The CRTW model was developed to coordinate surgical care with OHS, aiming to optimize RTW by prescribing short sick leave and facilitating workplace adjustments and rehabilitation.

Data Highlights

Key Findings

• The CRTW model includes a one-month surgeon-prescribed sick leave followed by systematic referral to occupational health services.
• Patients eligible for OHS who underwent surgery under the CRTW model returned to work faster than those receiving usual care.
• Subgroup analysis showed that patients with sick leave prescribed strictly according to the CRTW protocol had the most pronounced reduction in sick leave duration.
• Collaboration between surgical units and OHS facilitates individualized RTW planning, workplace adjustments, and rehabilitation support.
• Despite the model’s design, inconsistent application due to human factors was noted, highlighting the importance of protocol adherence.

Clinical Implications

Implementing a coordinated RTW approach that integrates surgical care with occupational health services can substantially reduce sick leave duration after hip or knee arthroplasty. Clinicians should ensure adherence to prescribed sick leave protocols and facilitate early occupational health referrals to optimize patient recovery and work reintegration. Workplace negotiations and tailored rehabilitation are key components supporting sustainable RTW.

Conclusion

The CRTW model effectively decreases sick leave duration and supports faster return to work after hip or knee replacement surgery in patients covered by occupational health services. Coordinated multidisciplinary care is essential to enhance postoperative recovery and minimize work absence.

References

1. Back At work After Surgery (BAAS) model study -- Effectiveness in RTW after knee arthroplasty
2. Finnish registry study on CRTW model -- Evaluation of RTW outcomes
3. Social Insurance Institution of Finland -- National Sickness Benefits Register