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Purpose To explore return-to-work (RTW) policies and practices for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients in three European countries. Materials and methods An exploratory study in Denmark, Germany, and the Netherlands consisting of three aspects: (1) description of the healthcare and social security systems; (2) identification of national RTW guidelines; (3) a survey to gain insight into RTW practices and perceptions of orthopaedic surgeons, including barriers, facilitators, and needs. Results Healthcare and social security systems differed (e.g. fast-track vs longer postoperative stay; coverage of rehabilitation costs). National guidelines were available in Germany (THA, TKA) and the Netherlands (TKA), containing limited RTW information. The survey was completed by 168 orthopaedic surgeons (Denmark n = 51; Germany n = 39; the Netherlands n = 78). Overall, orthopaedic surgeons reported being in need of more knowledge and better collaboration with other healthcare practitioners. Conclusion We found considerable variation in healthcare and social security systems. When available, national guidelines contained limited information. In all three countries surgeons need more knowledge and better collaboration with other healthcare practitioners. We advise that RTW multidisciplinary recommendations post THA/TKA be established by the national associations of the healthcare practitioners involved., Purpose: To explore return-to-work (RTW) policies and practices for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients in three European countries. Materials and methods: An exploratory study in Denmark, Germany, and the Netherlands consisting of three aspects: (1) description of the healthcare and social security systems; (2) identification of national RTW guidelines; (3) a survey to gain insight into RTW practices and perceptions of orthopaedic surgeons, including barriers, facilitators, and needs. Results: Healthcare and social security systems differed (e.g. fast-track vs longer postoperative stay; coverage of rehabilitation costs). National guidelines were available in Germany (THA, TKA) and the Netherlands (TKA), containing limited RTW information. The survey was completed by 168 orthopaedic surgeons (Denmark n = 51; Germany n = 39; the Netherlands n = 78). Overall, orthopaedic surgeons reported being in need of more knowledge and better collaboration with other healthcare practitioners. Conclusion: We found considerable variation in healthcare and social security systems. When available, national guidelines contained limited information. In all three countries surgeons need more knowledge and better collaboration with other healthcare practitioners. We advise that RTW multidisciplinary recommendations post THA/TKA be established by the national associations of the healthcare practitioners involved.

Osteoarthritis is expected to become the most prevalent chronic disorder in the Netherlands by 2040, with its incidence rising rapidly. Total hip or knee arthroplasty (THA/TKA) is considered the most cost-effective treatment for advanced hip or knee osteoarthritis, and its demand is increasing. Notably, more individuals of working age are opting for these procedures, leading to a shift in rehabilitation needs. We investigated the role of system-related factors (i.e. healthcare- and social security systems, clinical guidelines) and work-related factors (i.e. workplace characteristics, physical- and psychosocial working conditions, and work adjustments) on return to work, and factors associated with fulfilment of patient expectations towards paid employment for the growing group of working-age THA and TKA patients. The findings suggest that there are opportunities to enhance the current attention given to work, highlighting a lack of collaboration among healthcare professionals (orthopaedic surgeons and occupational physicians) and scarcity of guidelines. The thesis reveals that psychosocial working conditions (e.g. possibilities for personal job development, work recognition and quality of supervisor leadership) and expectations, not just physical working conditions (e.g. physical job tasks), play a crucial role in return to work. The insights from this research may improve care for workers undergoing a THA/TKA, advocating for a work-oriented approach. One way to achieve this, would be by incorporating the topic into multidisciplinary guidelines and healthcare provider education. The challenge ahead is to identify and implement multidisciplinary intervention strategies for sustainable RTW, fostering a well-connected care chain.