Systematic review and meta-analysis of outcomes in workers’ compensation patients following knee surgery

An increasing volume of orthopaedic procedures are being performed worldwide, particularly in the working age population. Workers’ compensation (WC) is an insurance framework designed to support workers who are injured or become injured and has been associated with poor outcomes following a number of orthopaedic procedures. This systematic review aims to investigate post-operative outcomes in WC compared with non-workers’ compensation (NWC) patients following knee arthroplasty and arthroscopy. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE and Google Scholar databases were assessed from inception to 9 th August 2025. Meta-analysis of WC undergoing knee arthroplasty was performed using Review Manager v5.4.1 using a random effects model. An initial 513 records were initially identified. Eight retrospective observation studies were included, consisting of five studies investigating arthroplasty and three studies investigating knee arthroscopy. Meta-analysis of the arthroplasty studies showed a significantly reduced Knee Society knee (MD = -16.14, P =0.002) and function (MD = -12.08, P <0.00001) scores, reduced range of motion (MD = -5.99, P =0.0002) and increased complications (OR = 5.83, P =0.03) in the WC group. There were reduced return to work rates or prolonged time off work. Moderate to high individual risk of bias were evident in the reviewed studies. WC status is associated with poorer Knee Society scores, reduced range of motion and increased complications following knee arthroplasty. However, the strength of evidence is low to moderate with serious biases with caution advised on its interpretation.