The impact of waiting for hip and knee arthroplasty in people of working age

Aims Hip and knee arthroplasty volumes are increasing among working-age patients with end-stage osteoarthritis (OA). This study aimed to assess pre- and postoperative work absence, return to work (RTW), workplace modifications, and the exploratory productivity impact associated with work disruption. Methods This retrospective cohort study included patients aged ≤ 65 years undergoing primary total hip (THA) or total knee arthroplasty (TKA) between April 2023 and March 2025 at a UK national elective orthopaedic centre (National Treatment Centre - Fife Orthopaedics, UK). Eligible patients completed outcome measures and a RTW questionnaire. Exploratory productivity modelling used gross value added (GVA)-based assumptions and national arthroplasty data to estimate potential productivity loss. Results Of the 92 patients included, 68 (73.9%) returned to work postoperatively. RTW was more frequent among patients aged < 50 years (n = 30/33, 90.9%) and after THA compared with TKA (n = 40 (85.1%) vs n = 28 (62.2%) respectively). Among those intending to RTW, 68/77 (88.3%) did so, with similar rates after THA (n = 40/44, 90.9%) and TKA (n = 28/33, 84.8%). Median time to RTW was 2.5 months (IQR 1.5 to 3.4). Initial work modifications were required by 46/68 (67.6%) patients, and nine of 77 (11.7%) patients intending to RTW either failed to return for joint-specific reasons, or lost/changed jobs due to their osteoarthritis or surgery. Preoperative work cessation occurred in 34/92 (37.0%) patients and was associated with failure to RTW (p = 0.004). Longer waiting times were associated with higher rates of preoperative work cessation, affecting 4.3%, 28.3%, and 33.7% of patients waiting three, 12, and 24 months, respectively. Illustrative GVA-based modelling estimated Scotland-wide productivity loss of £146 to 425 million annually. Conclusion Most working-age patients returned to work after arthroplasty, although many required work modifications. Preoperative work cessation was associated with non-return, and longer waiting list times were associated with greater modelled productivity loss. These exploratory findings support improved employment counselling, RTW pathway optimization, and prospective multicentre evaluation. Cite this article: Bone Jt Open 2026;7(11):1446–1454.