Return to work policies and practices after total hip or knee arthroplasty in Denmark, Germany, and the Netherlands: an exploratory study.

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. IMPLICATIONS FOR REHABILITATION: Orthopaedic surgeons (regardless of country) need more knowledge, including "guidelines", "scientific evidence", and "expertise with work/return-to-work", to adequately support return to work. Orthopaedic surgeons need better collaboration with other healthcare practitioners to adequately support total hip arthroplasty or total knee arthroplasty patients to return to work. Multidisciplinary recommendations for returning to work after total hip arthroplasty or total knee arthroplasty should be established by the national associations of the healthcare practitioners involved. [ABSTRACT FROM AUTHOR]