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Purpose: Optimizing return to work after knee arthroplasty is becoming more important because of the growing incidence of KA among workers and poor return to work outcomes. The purpose of this study is to investigate the feasibility of Back At work After Surgery (BAAS): an integrated clinical pathway for return to work after knee arthroplasty. Method: Working patients who received unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) between January 2021 and November 2021, younger than 65 years and motivated to return to work were eligible to participate. Feasibility was investigated on five domains: reach, dose delivered, dose received, fidelity and patients’ attitudes. These outcomes were obtained by a patient-reported questionnaire and an interview with the occupational case manager and medical case manager.Results: Of the eligible 29 patients, eleven were willing to participate (response rate 38%; due to travel distance to and from the hospital). The dose delivered was between 91 and 100%, except information given about return to work from the orthopedic surgeon which was 18%. The dose received was 100%. For fidelity, case managers reported nine shortcomings for which five solutions were mentioned. In terms of patients’ attitude, all patients were satisfied and one patient mentioned an improvement. Conclusions: In terms of reach, participation was low: only 29%. The BAAS clinical pathway seems feasible based on dose delivered, dose received, fidelity and patient attitudes. The next step is to assess the effectiveness of the BAAS clinical pathway for return to work.

Introduction Research has linked high occupational demands to multiple adverse health outcomes, both physical and mental. As far as we know, researchers have not identified the profile characteristics of military police personnel based on occupational demands. The current study aims to identify profiles based on self-perceived occupational demands and work-related factors. This study is a starting point for characterizing performance and health in a military police population. Methods This was a cross-sectional study in which we gathered survey data from 1,135 Royal Netherlands Marechaussee members. We used Latent Profile Analysis to identify profiles based on nine indicators of workload and work characteristics selected via focus groups and interviews with Royal Netherlands Marechaussee personnel. We determined if the profiles differed significantly across all indicators with an analysis of variance. Then, we used binominal logistic regression to determine the odds ratio (OR) for the indicators on profile membership. Results We discovered two profiles that were distinct across all indicators. Experience (OR = 1.02, 95% CI [1.00–1.04]), autonomy (OR = 1.18, 95% CI [1.06–1.31]), task clarity (OR = 1.49, [1.32–1.69]), and work support (OR = 2.63, 95% CI [2.26–3.09]) were all predictors for a low perceived occupational demand profile. In contrast, mental (OR = 0.18, 95% CI [0.13–0.25]) and physical (OR = 0.42, 95% CI [0.32–0.54]) fatigue, and boredom (OR = 0.14, 95% CI [0.10–0.20]) were predictors for high perceived occupational demand profiles. Conclusion We established two distinct profiles that describe the characteristics reported by the Royal Netherlands Marechaussee personnel based on workload and work characteristics. High scores on autonomy, work support, and task clarity predict favorable perceived occupational demands, whereas fatigue and boredom predict unfavorable occupational demands. Remarkably, the physical workload did not predict high perceived occupational demands.

Sand–cement-bound screed floor layers are at risk of work-related lower back pain, lumbosacral radicular syndrome and knee osteoarthritis, given their working technique of levelling screed with their trunk bent while mainly supported by their hands and knees. To reduce the physical demands of bending of the trunk and kneeling, a manually movable screed-levelling machine was developed for floor layers in the Netherlands. The aim of this paper is to estimate the potential health gains of working with a manually movable screed-levelling machine on the risk of lower back pain (LBP), lumbosacral radicular syndrome (LRS) and knee osteoarthritis (KOA) compared to traditional working techniques. This potential health gain was assessed using the epidemiological population estimates of the Population Attributable Fraction (PAF) and the Potential Impact Fraction (PIF), combined with work-related risk estimates for these three disorders from systematic reviews. The percentage of workers exceeding these risk estimates was based on worksite observations among 28 floor layers. For LBP, 16/18 workers were at risk when using traditional working techniques, with a PAF = 38%, and for those using a manually movable screed-levelling machine, this was 6/10 with a PIF = 13%. For LRS, these data were 16/18 with a PAF = 55% and 14/18 with a PIF = 18%, and for KOA, 8/10 with a PAF = 35% and 2/10 with a PIF = 26%. A manually movable screed-levelling machine might have a significant impact on the prevention of LBP, LRS and KOA among floor layers in the Netherlands, and health-impact assessments are a feasible approach for assessing health gains in an efficient way.

Background: Lateral epicondylitis (LE) is a highly prevalent musculoskeletal disorder in workers, often associated with physically demanding work. Knowledge of work-relatedness of LE is crucial to develop appropriate preventive measures. This study investigates the prospective association between work-related physical risk factors and LE. Methods: A systematic literature review was conducted in MedLine using PubMed from January 1, 2010 until February 16, 2021. Published reports were included if: (1) LE was clinically assessed, (2) exposure to work-related physical risk factors was assessed, and (3) associations between LE and work-related physical risk factors were reported in prospective studies. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation. Results: In total, 318 workers with LE from a population of 5036 workers in five studies were included. Meta-analyses revealed high-quality evidence for associations between LE and a Strain Index (SI) score >5.1 (odds ratio [OR]: 1.75, 95% confidence interval (CI): 1.11–2.78) and moderate-quality evidence for forearm rotation >4 h/day or forearm rotation ≥45° for ≥45% time (OR: 1.85, 95% CI: 1.10–3.10). Gripping, flexion and extension of the wrist, and repetitive movements showed no significant associations with LE. Conclusion: High-quality evidence was found indicating that a higher SI increased the risk of LE. Moderate-quality evidence was found for an association between forearm rotation and LE. No associations were found between other physical risk factors and LE. Primary preventive interventions should focus on a reduction of the SI and of high forearm rotation in work.

BACKGROUND: Return to work (RTW) is an important outcome in Total Knee Arthroplasty (TKA). At present, 70-80% of TKA patients return to work within three to six months.OBJECTIVE: What are patients' perspectives regarding beneficial and limiting factors in RTW after TKA?METHODS: Focus groups were formed in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Three major topics were explored: 1. What was beneficial for RTW after TKA; 2. What was limiting for RTW after TKA; and 3. What additional care would benefit RTW after TKA?RESULTS: Data saturation was reached after four focus groups, comprising 17 participants-nine men and eight women (median age 58, range 52-65). The focus group study identified four main themes that contributed to a successful RTW namely rehabilitation (medical) like post-operative physical therapy, patient characteristics (personal), like motivation to RTW, occupational characteristics (work-related) like build-up in work tasks and medical support (medical) like availability of a walker or crutches.CONCLUSION: According to participants, factors within the following four themes can contribute to a successful return to work: occupational, patient, rehabilitation and medical care. Incorporating these factors into the integrated care pathway for the "young" TKA patients may increase the chances of a successful RTW.

Background and purpose: Recommendations concerning the return to daily life activities, including work and sport, after knee arthroplasty (KA) are essential for setting realistic patient expectations. Fulfillment of these expectations contributes to more satisfaction and enhanced recovery after KA. However, scientific evidence for such recommendations is limited, and recommendations are often based only on healthcare professionals’ expert opinions. We summarized the current recommendations regarding return to daily life activities provided by Dutch hospitals and clinics to KA patients.Material and methods: Recommendations of 43 Dutch hospitals and clinics were identified, representing the advice provided to 70% of the total Dutch KA patients. Recommendations were retrieved from content from websites (n = 8), brochures (n = 40), and mobile phone applications (n = 9).Results: Recommendations for 24 daily life activities were identified. Individual hospitals and clinics provided recommendations for, on average, 9 (0–15) of these activities. Recommendations varied greatly. For example, recommendations regarding when to resume cycling after KA were provided by 36 of the 43 hospitals and clinics and varied from 3 weeks to 3 months.Interpretation: Recommendations for return to daily life activities are often missing and vary considerably between Dutch hospitals and clinics. These findings show the need for more uniformity across healthcare providers regarding recommendations for postoperative return to daily life activities.

Background: This case report describes whether a female civil servant who developed bilateral ulnar neuropathy can be classified as having an occupational disease. Methods: The Dutch six-step protocol for the assessment and prevention of occupational diseases is used. Results: Based on the six-step protocol, we propose that pressure on the ulnar nerve in the elbow region precipitated the neuropathy for this employee while working prolonged periods in elbow flexion with a laptop. Conclusion: Despite the low incidence laptop use might be a risk factor for the occurrence of ulnar neuropathy due to prolonged pressure on the elbow. Employers and workers need to be educated about this disabling occupational injury due to laptop use and about protective work practices such as support for the upper arm and elbow. This seems especially relevant given the trend of more flexible workspaces inside and outside offices, and given the seemingly safe appearance of laptop use.

Background and purpose - Guidelines for managing hip and knee osteoarthritis (OA) advise extensive non-surgical treatment prior to surgery. We evaluated what percentage of hip and knee OA patients received non-surgical treatment prior to arthroplasty, and assessed patient satisfaction regarding alleviation of symptoms and performance of activities. Patients and methods - A multi-center cross-sectional study was performed in 2018 among 186 patients who were listed for hip or knee arthroplasty or had undergone surgery within the previous 6 months in the Netherlands. Questions concerned non-surgical treatments received according to the Stepped Care Strategy and were compared with utilization in 2013. Additionally, satisfaction with treatment effects for pain, swelling, stiffness, and activities of daily life, work, and sports/leisure was questioned. Results - The questionnaire was completed by 175 patients, age 66 years (range 38-84), 57% female, BMI 29 (IQR 25-33). Step 1 treatments, such as acetaminophen and lifestyle advice, were received by 79% and 60% of patients. Step 2 treatments, like exercise-based therapy and diet therapy, were received by 66% and 19%. Step 3-intra-articular injection-was received by 47%. Non-surgical treatment utilization was lower than in 2013. Nearly all treatments showed more satisfied patients regarding pain relief and fewer regarding activities of work/sports/leisure. Hip and knee OA patients were mostly satisfied with NSAIDs for all outcomes, while exercise-based therapy was rated second best. Interpretation - Despite international guideline recommendations, non-surgical treatment for hip and knee OA remains underutilized in the Netherlands. Of the patients referred for arthroplasty, more were satisfied with the effect of non-surgical treatment on pain than on work/sports/leisure participation.

In the upcoming decades, hospitals and clinics around the world face a steep rise in demand from patients seeking knee replacement surgery. An absolute increase in knee replacement surgery of 297% – to 57 893 procedures – is forecasted in The Netherlands between 2005 and 2030 (1). The situation is similar in many countries: Sweden, 163% to 21 700 (2013–2030) (2); Italy, 45% to about 100 000 (2017–2050) (3), the UK, 916% to about 1.2 million (2015–2035) (4); Australia, 276% to 65 569 (2013–2030) (5); and the USA, 673% to 3.48 million (2005–2030) (6). No projections are available for Asia, however, similar growth percentages have already been seen in Japan of 373% (2007–2014) (7) and Korea (407%, 2001–2010) (8). Knee replacement surgery or arthroplasty is the final treatment option for patients suffering from knee osteoarthritis (OA). These increasing numbers are alarming, not only due to the extreme high demands on healthcare provision and budgets, but also for the unforeseen impact on work participation. There is a lack of awareness how work might play a significant role in reducing the steep rise in replacement surgery for knee OA across the world. Unforeseen impact on work The largest increase in primary surgery demands is not among the classic knee arthroplasty population of patients aged 70 years and older, but among patients of working age (1–4, 9). For instance, Germany – one of the leading countries in the prevalence of knee arthroplasty – foresees the highest increase in patients aged 50– 65 years until 2050 (10), and in a similar study using the same database even among patients aged 40–49 years until 2040 (11). In several countries, the current proportion of knee arthroplasty patients under 65 years is already substantial at 30–40%. It is expected in 2030 that the USA will be the first country where the majority of these patients will be younger than 65 years (6), followed by the UK in 2035 (4). This increase in surgery and shift towards younger age groups can largely be explained by good clinical and cost-effective long-term outcomes, no clear threshold for surgery, and the rising number of younger and more demanding knee OA patients (9). Originally, knee arthroplasty was mainly aimed at reducing pain, improving knee function and thereby enhancing the performance of activities of daily life in the patient population aged 70 years and older. The current success was totally unforeseen by LG Shiers, the founding father of knee arthroplasty (12). In 1954, he concluded: "… few surgeons will ever see 50 patients requiring arthroplasty, let alone operate on them, even in five years". Nowadays, specialized orthopedic surgeons perform this procedure several times per day. Despite the good clinical outcomes, return to work is not that favorable after surgery. About two of every ten working-age patients are dissatisfied with their work ability due to their knee arthroplasty (13). The majority of workers return to their original or other work only after six months (13,14), and about three of every ten patients do not return to their original or other work after a year (13,15). Especially performance of knee-demanding activities like kneeling, crouching and clambering does not improve after surgery (16). The rapid adaptation of knee arthroplasty as preferred clinical practice for working-age knee OA patients has profound consequences for functioning at work and labor force participation. These consequences receive little-to-no attention in current clinical guidelines and yet are increasingly important outcomes for patients of working age (17, 18). Therefore, occupational health professionals around the world face the urgent challenge to develop evidence of how to improve a patient’s ability for sustained employability – as an essential value in life – after surgery (19). Promising initiatives have recently been described although not validated for work participation yet (20–23). More importantly, occupational health professionals should play a primary role in reducing the steep increase in replacement surgery by mitigating the risk of knee OA. Work to reduce knee osteoarthritis and hospitalization Until now, little-to-no attention has been given to work as a promising point of engagement for the prevention of knee OA and subsequent hospitalization. A nationwide representative prospective Finnish study showed that high body mass index, prior knee injury, and an intermediate-to-high cumulative physical workload accounted for 70% of hospitalizations due to knee OA (23). Bearing these three modifiable risk factors in mind, preventive strategies at work seem warranted to reduce both the incidence of knee OA and, of course, the associated hospitalization. Primary prevention at work might mitigate all three risk factors. Without question, losing excessive body weight is key (23). Proper & Van Oostrom (24) concluded in their review on health promotion intervention, that strong evidence exists for favorable effects of weight reduction, especially for interventions targeting diet and/or physical activity. Regarding knee injury and cumulative physical workload, reducing the time kneeling and squatting at work appears highly promising to tackle both (25–27). The upcoming EU-OSHA campaign 2020–2022 ‘Healthy Workplaces Lighten the Load’ starting October 2020 is an excellent opportunity to focus on this specific occupational disease. Intensive interventions tailored to the specific target group are promising to reduce the risk of knee OA (28-30). This approach is in line with the general risk assessment strategies to safeguard workers’ health and safety and, therefore, Labor Inspectorates can effectively enforce compliance with the occupational safety and health regulations (31). Moreover, the proposed combined interventions on lifestyle and workplace adaptations are also in line with the stepped-care strategy for secondary prevention of knee OA (32) and of course tertiary prevention by bringing the rising hospital admission curve to its knees and thereby contributing to better health and prolonged working lives of workers at risk of "running out of cartilage". References 1. Otten R, van Roermund PM, Picavet HS. Trends in aantallen knie- en heupartroplastieken: de vraag naar knie- en heupprotheses blijft voorlopig toenemen [Trends in the number of knee and hip arthroplasties: considerably more knee and hip prostheses due to osteoarthritis in 2030]. Ned Tijdschr Geneeskd. 2010;154:A1534. pubmed.ncbi.nlm.nih.gov/20619009/ 2. Nemes S, Rolfson O, W-Dahl A, et al. Historical view and future demand for knee arthroplasty in Sweden. Acta Orthop. 2015;86(4):426-431. doi.org/10.3109/17453674.2015.1034608 3. Romanini, E, Decarolis F, Luzi I, Zanoli G, Venosa M, Laricchiuta P, et al. Total knee arthroplasty in Italy: reflections from the last fifteen years and projections for the next thirty. Int Orthop. (SICOT). 2019;43:133–138. doi.org/10.1007/s00264-018-4165-7 4. Culliford D, Maskell J, Judge A, Cooper C, Prieto-Alhambra D, Arden NK, et al. Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. Osteoarthr Cartilage. 2015;23(4):594-600. doi.org/10.1016/j.joca.2014.12.022 5. Ackerman IN, Bohensky MA, Zomer E, Tacey M, Gorelik A, Brand CA, et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord. 2019;20(1):90. doi.org/10.1186/s12891-019-2411-9 6. 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The projected volume of primary and revision total knee arthroplasty will place an immense burden on future heath care systems over the next 30 years. [published online ahead of print, 2020 Jul 15] Knee Surg Sports Traumatol Arthrosc. 2020;1-12. doi.org/10.1007/s00167-020-06154-7 11. Rupp M, Lau E, Kurtz SM, Alt V. Projections of primary TKA and THA in Germany from 2016 through 2040. Clin Orthop Relat Res. 2020; 478(7):1622-1633. doi: 10.1097/CORR.0000000000001214 12. Shiers LG. Arthroplasty of the knee; preliminary report of new method. The Journal of Bone and Joint surgery. British Volume. 1954;36-B(4):553-560. pubmed.ncbi.nlm.nih.gov/13211730/ 13. Kievit AJ, van Geenen RC, Kuijer PP, Pahlplatz TM, Blankevoort L, Schafroth MU. Total knee arthroplasty and the unforeseen impact on return to work: a cross-sectional multicenter survey. J Arthroplasty. 2014;29(6):1163-1168. doi.org/10.1016/j.arth.2014.01.004 14. Hylkema TH, Brouwer S, Stewart RE, van Beveren J, Rijk PC, Brouwer RW, et al. Two-year recovery courses of physical and mental impairments, activity limitations, and participation restrictions after total knee arthroplasty among working-age patients. Disabil Rehabil. 2020;1-10. doi.org/10.1080/09638288.2020.1766583 15. Leichtenberg CS, Tilbury C, Kuijer PPFM, Verdegaal SHM, Wolterbeek R, Nelissen RGHH, et al. Determinants of return to work 12 months after total hip and knee arthroplasty. Ann R Coll Surg Engl. 2016;98(6):387-395. doi.org/10.1308/rcsann.2016.0158 16. Kievit AJ, Kuijer PPFM, de Haan LJ, Koenraadt KLM, Kerkhoffs GMMJ, Schafroth MU, et al. Patients return to work sooner after unicompartmental knee arthroplasty than after total knee arthroplasty. [published online ahead of print, 2019 Aug 30] Knee Surg Sports Traumatol Arthrosc. doi.org/10.1007/s00167-019-05667-0 17. Bardgett M, Lally J, Malviya A, Deehan D. Return to work after knee replacement: a qualitative study of patient experiences. BMJ Open 2016;6(2):e007912. doi.org/10.1136/bmjopen-2015-007912 18. Witjes S, van Geenen RC, Koenraadt KL, van der Hart CP, Blankevoort L, Kerkhoffs GMMJ, et al. Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions?. Qual Life Res. 2017;26(2):403-417. doi.org/10.1007/s11136-016-1380-9 19. Coenen P, Hulsegge G, Daams JG, van Geenen RC, Kerkhoffs GM, van Tulder MW, et al. Integrated care programmes for sport and work participation, performance of physical activities and quality of life among orthopaedic surgery patients: a systematic review with meta-analysis. BMJ Open Sport & Exercise Medicine 2020;6:e000664. doi.org/10.1136/bmjsem-2019-000664 20. Hoorntje A, Waterval-Witjes S, Koenraadt KLM, Kuijer PPFM, Blankevoort L, Kerkhoffs GMMJ, et al. Goal attainment scaling rehabilitation improves satisfaction with work activities for younger working patients after knee arthroplasty: results from the randomized controlled ACTION trial. J Bone Joint Surg Am. 2020;00:1-9doi.org/10.2106/JBJS.19.01471 21. Straat AC, Coenen P, Smit DJM, Hulsegge G, Bouwsma EVA, Huirne JAF, et al. Development of a Personalized m/eHealth Algorithm for the Resumption of Activities of Daily Life Including Work and Sport after Total and Unicompartmental Knee Arthroplasty: A Multidisciplinary Delphi Study. Int. J. Environ. Res. Public Health 2020;17(14): 4952. https://doi.org/10.3390/ijerph17144952 22. Coole C, Baker P, McDaid C, Drummond A. Using intervention mapping to develop an occupational advice intervention to aid return to work following hip and knee replacement in the United Kingdom. BMC Health Serv Res 2020;20:523 https://doi.org/10.1186/s12913-020-05375-3 23. Kontio T, Heliövaara M, Viikari-Juntura E, Solovieva S. To what extent is severe osteoarthritis preventable? Occupational and non-occupational risk factors for knee and hip osteoarthritis. Rheumatology (Oxford). 2020;keaa238. doi.org/10.1093/rheumatology/keaa238 24. Proper KI, van Oostrom SH. The effectiveness of workplace health promotion interventions on physical and mental health outcomes - a systematic review of reviews. Scand J Work Environ Health. 2019;45(6):546-559. doi.org/10.5271/sjweh.3833 25. Hong CY, Lee CG, Kim DH, Cho YS, Kim KY, Ryu SY, Song HS, Workrelated risk factors of knee meniscal tears in korean farmers: a cross-sectional study. Saf Health Work. doi.org/10.1016/j.shaw.2020.05.008. 26. Rytter S, Jensen LK, Bonde JP, Jurik AG, Egund N. Occupational kneeling and meniscal tears: a magnetic resonance imaging study in floor layers. J Rheumatol. 2009;36(7):1512-1519. doi.org/10.3899/jrheum.081150 27. Verbeek J, Mischke C, Robinson R, Ijaz S, Kuijer P, Kievit A, et al. Occupational Exposure to Knee Loading and the Risk of Osteoarthritis of the Knee: A Systematic Review and a Dose-Response Meta-Analysis. Saf Health Work. 2017;8(2):130-142. doi.org/10.1016/j.shaw.2017.02.001 28. van der Beek AJ, Kunst AE. How can we break the vicious circle between poor health and exit from paid employment?. Scand J Work Environ Health. 2019;45(4):321-323. doi.org/10.5271/sjweh.3838 29. Visser S, van der Molen HF, Kuijer PP, Sluiter JK, Frings-Dresen MH. Stand up: comparison of two electrical screed levelling machines to reduce the work demands for the knees and low back among floor layers. Ergonomics. 2016;59(9):1224-1231. doi.org/10.1080/00140139.2015.1122233 30. Mikkelsen S, Pedersen EB, Brauer C, Møller KL, Alkjaer T, Koblauch H, Simonsen EB, Thygesen LC. Knee osteoarthritis among airport baggage handlers: A prospective cohort study. Am J Ind Med. 2019;62(11):951-960. doi.org/10.1002/ajim.23044 31. 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Purpose Clinicians need to know whether inguinal hernia (IH) can be attributed to work to answer questions regarding prevention and medical causation. This review describes whether work-related risk factors are associated with IH. Methods A systematic review was performed in Medline via PubMed until February 3rd, 2020. Inclusion criteria were that IH was diagnosed by a clinician, and workers exposed to work-related risk factors were compared to workers less exposed or not at all. A quality assessment and a meta-analysis using Cochrane’s RevMan 5.3 were performed, including GRADE for quality of evidence. Results The search resulted in 540 references. Fourteen studies fulfilled the inclusion criteria, of which three were included in a meta-analysis, all three being of high quality, including 621 workers diagnosed with IH. The meta-analysis revealed significant associations with physically demanding work (OR 2.30, 95% CI 1.56–3.40). Two prospective studies, including 382 and 22,926 cases revealed associations that this was true for male workers with a lateral IH that reported standing or walking for more than six hours per workday (OR 1.45, 95% CI 1.12–1.88) or lifting cumulative loads of more than 4000 kg per workday (OR 1.32, 95% CI 1.27–1.38). The level of certainty for the latter two work-related risk factors was moderate and high according to GRADE. Conclusion Lateral IH among males is associated with work-related risk factors depending on the level of exposure to the time standing/walking per workday, or the amount of load lifted per workday.

Background: Especially in younger knee osteoarthritis patients, the ability to perform physical activity (PA) after knee arthroplasty (KA) is of paramount importance, given many patients’ wish to return to work and perform demanding leisure time activities. Goal Attainment Scaling (GAS) rehabilitation after KA may improve PA because it uses individualized activity goals. Therefore, our aim was to objectively quantify PA changes after KA and to compare GAS-based rehabilitation to standard rehabilitation. Methods: Data were obtained from the randomized controlled ACTION trial, which compares standard rehabilitation with GAS-based rehabilitation after total and unicompartmental KA in patients

Rationale: Explore the MRI-appearance of the healthy distal radial physis and the distribution of stress-related changes in physeal thickness in young gymnasts to aid in the understanding of the pathophysiological process of stress-related physeal injury. Methods: Symptomatic gymnasts with clinically suspected overuse injury of the distal radial physis and age and gender-matched asymptomatic gymnasts and healthy non-gymnasts underwent an MRI-scan of the wrist. A cartilage-specific sequence was used to obtain three-dimensional reconstructions of the distal radial physis. Heat maps and line charts of these reconstructions visualised distribution of physeal thickness per study group and were used to explore differences between study groups. Symptomatic gymnasts displaying the most profound physeal widening (n = 10) were analysed separately. Results: Twenty-seven symptomatic–(skeletal age 12.9 ± 1.5 years), 16 asymptomatic–(skeletal age 12.8 ± 1.9 years) and 23 non-gymnasts (skeletal age 13.6 ± 1.9 years) were included for analysis. Physes of healthy non-gymnasts had a thin centre and increased in thickness towards the borders. Gymnasts demonstrated an increase in thickness of the entire physeal surface. In symptomatic gymnasts increase in physeal thickness was most prominent at the volar side when compared to asymptomatic gymnasts and non-gymnasts. Conclusion: The healthy distal radial physis is characterised by a thin centre surrounded by thicker borders. Stress applied to the wrist during gymnastics causes an overall increase in physeal thickness. Profound thickness increase is present at the volar side of the physis mainly in symptomatic gymnasts. These results can help unravel the pathophysiological mechanism of stress-related physeal injury in gymnasts and aid early injury identification.

To explore the use of quantitative volume assessment to identify the presence and extent of stress-related changes of the distal radial physis in gymnasts with suspected physeal injury, asymptomatic gymnasts, and non-gymnasts. Symptomatic gymnasts with clinically suspected distal radial physeal injury, asymptomatic gymnasts, and non-gymnasts (n = 69) were included and matched on skeletal age and sex. Volume measurements were performed on coronal water selective cartilage MRI images by creating three-dimensional physeal reconstructions semi-automatically using active-contour segmentation based on image-intensity thresholding. Inter- and intra-rater reliability of the measurements were assessed using intra-class correlation coefficients (ICC) for absolute agreement. Twenty-seven symptomatic-, 18 asymptomatic-, and 24 non-gymnasts were included with a median age of 13.9 years (interquartile range (IQR) 13.0–15.0 years). Median physeal volume was significantly increased (p

Purpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation “to advise”, low to very low in a recommendation “to consider”, unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines “lifting” and “whole body vibration”. The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.

Purpose Three out of ten patients do not return to work after total knee arthroplasty (TKA). Patient expectations are suggested to play a key role. What are patients’ expectations regarding the ability to perform work-related knee-demanding activities 6 months after TKA compared to their preoperative status? Methods A multi-center cross-sectional study was performed among 292 working patients listed for TKA. The Work Osteoarthritis or joint-Replacement Questionnaire (WORQ, range 0–100, minimal important difference 13) was used to assess the preoperatively experienced and expected ability to perform work-related knee-demanding activities 6 months postoperatively. Differences between the preoperative and expected WORQ scores were tested and the most difficult knee-demanding work-related activities were described. Results Two hundred thirty-six working patients (81%) completed the questionnaire. Patients’ expected WORQ score (Median = 75, IQR 60–86) was significantly (p

Purpose: It is not yet known if unicompartmental knee arthroplasty (UKA) patients are more likely to return to work sooner or have improved ability to work (i.e., workability) than total knee arthroplasty (TKA) patients. The following questions were addressed: patients were assessed to determine: (1) whether they returned to work sooner following UKA compared to TKA; (2) whether UKA patients had better WORQ function scores compared to TKA patients; and (3) if UKA patients have higher workability scores and greater satisfaction regarding workability than TKA patients. Methods: A multicenter retrospective cohort study was performed that included patients at least 2 years after having undergone either UKA or TKA surgery and on the condition that patients had been in work in the 2 years prior to surgery. Time period between stopping work and returning to work was assessed; the WORQ scores (0 = worst–100 = best) and the Work Ability Index (WAI = 0–10) and reported satisfaction with work ability. Results: UKA patients (n = 157, median 60 years, 51% male) were compared to TKA patients (n = 167, median 60 years, 49% male) (n.s.). Of the 157 UKA patients, 115 (73%) returned to work within 2 years compared to 121 (72%) of TKA patients (n.s.). More UKA patients return to work within 3 months (73% versus 48%) (p < 0.01). WORQ scores improved similarly in both groups. The WAI was also comparable between the groups. Dissatisfaction with workability was comparable (UKA 15% versus TKA 18% (n.s.). Conclusion: TKA and UKA patients have similar WORQ, WAI, and satisfaction scores. However, in this study population, UKA patients to return to work after surgery significantly sooner than TKA patients, which improves their quality of life and allows them to participate actively in society. This information can help health care providers and patients weigh-up the pros and cons and choose the best treatment and timing for patients in the working population. Level of evidence: III.

Sciatica impacts on the ability to work and may lead to a reduced return to work. This study reviewed and summarised prognostic factors of work participation in patients who received conservative or surgical treatment for clinically diagnosed sciatica. We searched MEDLINE, CINAHL, EMBASE and PsycINFO until January 2018. Cohort studies, using a measure of work participation as outcome, were included. Two independent reviewers performed study inclusion and used the Quality In Prognosis Studies tool for risk of bias assessment and GRADE to rate the quality of the evidence. Based on seven studies describing six cohorts (n=1408 patients) that assessed 21 potential prognostic factors, favourable factors for return to work (follow-up ranging from 3 months to 10 years) included younger age, better general health, less low back pain or sciatica bothersomeness, better physical function, negative straight leg raise-test, physician expecting surgery to be beneficial, better pain coping, less depression and mental stress, less fear of movement and low physical work load. Study results could not be pooled. Using GRADE, the quality of the evidence ranged from moderate to very low, with downgrading mainly for a high risk of bias and imprecision. Several prognostic factors like pain, disability and psychological factors were identified and reviewed, and these could be targeted using additional interventions to optimise return to work. PROSPERO registration number: CRD42016042497.

Background: High tibial osteotomy (HTO) is increasingly used in young and physically active patients with knee osteoarthritis. These patients have high expectations, including return to sport (RTS). By retaining native knee structures, a return to highly knee-demanding activities seems possible. However, evidence on patient-related outcomes, including RTS, is sparse. Also, time to RTS has never been described. Furthermore, prognostic factors for RTS after HTO have never been investigated. These data may further justify HTO as a surgical alternative to knee arthroplasty. Purpose: To investigate the extent and timing of RTS after HTO in the largest cohort investigated for RTS to date and to identify prognostic factors for successful RTS. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients with HTO, operated on between 2012 and 2015, received a questionnaire. First, pre- and postoperative sports participation questions were asked. Also, time to RTS, sports level and frequency, impact level, the presymptomatic and postoperative Tegner activity score (1-10; higher is more active), and the postoperative Lysholm score (0-100; higher is better) were collected. Finally, prognostic factors for RTS were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. Results: We included 340 eligible patients of whom 294 sufficiently completed the questionnaire. The mean follow-up was 3.7 years (± 1.0 years). Out of 256 patients participating in sports preoperatively, 210 patients (82%) returned to sport postoperatively, of whom 158 (75%) returned within 6 months. We observed a shift to participation in lower-impact activities, although 44% of reported sports activities at final follow-up were intermediate- or high-impact sports. The median Tegner score decreased from 5.0 (interquartile range [IQR], 4.0-6.0) presymptomatically to 4.0 (IQR, 3.0-4.0) at follow-up ( P < .001). The mean Lysholm score at follow-up was 68 (SD, ± 22). No significant differences were found between patients with varus or valgus osteoarthritis. The strongest prognostic factor for RTS was continued sports participation in the year before surgery (odds ratio, 2.81; 95% CI, 1.37-5.76). Conclusion: More than 8 of 10 patients returned to sport after HTO. Continued preoperative sports participation was associated with a successful RTS. Future studies need to identify additional prognostic factors.

In Nederland neemt het aantal totale knieprothesepatienten de komende jaren sterk toe. Het RIVM verwacht een stijging van 300% tot een aantal van 57.900 per jaar in 2030.1 De helft van deze patienten is dan jonger dan 65 jaar. Deze ‘jonge’ patienten vinden het belangrijk om weer te werken na hun operatie.2 Dit aantal is mogelijk nog groter, als ook de pensioengerechtigde leeftijd verder stijgt.3 Over wat de kenmerken zijn van effectieve arbeidsgerichte zorg is weinig bekend.3 Het doel van deze studie is om vast te stellen wat totale knieprothesepatienten die door een bedrijfsarts zijn begeleid ervaarden als belemmerende en bevorderende factoren voor werkhervatting. Twee groepen patienten zijn vergeleken: een groep die binnen zes maanden weer volledig aan het werk was tegenover een groep die langer dan zes maanden nodig had om volledig te werken.4

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that occupational exposure to ergonomic risk factors may cause selected other musculoskeletal diseases, other than back or neck pain (MSD) or osteoarthritis of hip or knee (OA). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of disability-adjusted life years from MSD or OA that are attributable to occupational exposure to ergonomic risk factors, for the development of the WHO/ILO Joint Estimates. Objectives: We aimed to systematically review and meta-analyse estimates of the effect of occupational exposure to ergonomic risk factors (force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing) on MSD and OA (two outcomes: prevalence and incidence). Data sources: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the International Trials Register, Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. Study eligibility and criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (

Background The aim of this study was to identify case definitions of diagnostic criteria for specific musculoskeletal disorders (MSDs) for use in occupational healthcare, surveillance or research. Methods A scoping review was performed in Medline and Web of Science from 2000 to 2020 by an international team of researchers and clinicians, using the Arksey and O’Malley framework to identify case definitions based on expert consensus or a synthesis of the literature. Seven MSDs were considered: non-specific low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral or medial elbow tendinopathy, and knee and hip osteoarthritis (OA). Case definitions for occupational healthcare or research were charted according to symptoms, signs and instrumental assessment of signs, and if reported, on work-related exposure criteria. Results In total, 2404 studies were identified of which 39 were included. Fifteen studies (38%) reported on non-specific LBP, followed by knee OA (n = 8;21%) and CTS (n = 8;21%). For non-specific LBP, studies agreed in general on which symptoms (i.e., pain in lower back) and signs (i.e., absence of red flags) constituted a case definition while for the other MSDs considerable heterogeneity was found. Only two studies (5%), describing case definitions for LBP, CTS, and SAPS and lateral and medial elbow tendinopathy respectively, included work-related exposure criteria in their clinical assessment. Conclusion We found that studies on non-specific LBP agreed in general on which symptoms and signs constitute a case definition, while considerable heterogeneity was found for the other MSDs. For prevention of work-related MSDs, these MSD case definitions should preferably include work-related exposure criteria.

Purpose This study compared the preoperative levels and postoperative recovery courses of physical and mental impairments, activity limitations and participation restrictions of working-age patients who return to work (RTW) by 3, 6 or 12 months after total knee arthroplasty (TKA). Methods A prospective survey study including TKA patients (aged Results Preoperative knee-specific pain and physical functioning levels were better among patients who RdTW by 3 months, compared to those who returned by 12 months. Patients who RdTW by 3 months experienced significantly better recovery from physical impairments than those who returned by 6 months (on general pain) or 12 months (on general and knee-specific pain and on stiffness). Patients returning by 3 months experienced significantly better recovery from activity limitations (on knee-specific physical functioning). Conclusions To optimize return to work outcome after TKA surgery, the focus should lie on physical impairments (general and knee-specific pain, stiffness) and activity limitations (knee-specific physical functioning) during recovery.

Additional file 3. Study characteristics and MSD case definitions of included studies.

International audience; Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic and human data suggests that occupational exposure to ergonomic (or physical) risk factors may cause osteoarthritis and other musculoskeletal diseases (excluding rheumatoid arthritis, gout, and back and neck pain). In this paper, we present a systematic review and meta-analysis of the prevalence of occupational exposure to physical ergonomic risk factors for estimating the number of disability-adjusted life years from these diseases that are attributable to exposure to this risk factor, for the development of the WHO/ILO Joint Estimates. Objectives: We aimed to systematically review and meta-analyse estimates of the prevalence of occupational exposure to ergonomic risk factors for osteoarthritis and other musculoskeletal diseases. Data sources: We searched electronic bibliographic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. Study eligibility and criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (andlt;15 years) and unpaid domestic workers. The exposure was defined as any occupational exposure to one or more of: force exertion, demanding posture, repetitive movement, hand-arm vibration, kneeling or squatting, lifting, and/or climbing. We included all study types with an estimate of the prevalence of occupational exposure to ergonomic risk factors. Study appraisal and synthesis methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We combined prevalence estimates using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using the ROB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates. Results: Five studies (three cross-sectional studies and two cohort studies) met the inclusion criteria, comprising 150,895 participants (81,613 females) in 36 countries in two WHO regions (Africa, Europe). The exposure was generally assessed with questionnaire data about self-reported exposure. Estimates of the prevalence of occupational exposure to ergonomic risk factors are presented for all five included studies, disaggregated by country, sex, 5-year age group, industrial sector or occupational group where feasible. The pooled prevalence of any occupational exposure to ergonomic risk factors was 0.76 (95% confidence interval 0.69 to 0.84, 3 studies, 148,433 participants, 35 countries in the WHO Europe region, I2 100%, low quality of evidence). Subgroup analyses found no statistically significant differences in exposure by sex but differences by age group, occupation and country. No evidence was found for publication bias. We assessed this body evidence to be of low quality, based on serious concerns for risk of bias due to exposure assessment only being based on self-report and for indirectness due to evidence from two WHO regions only. Conclusions: Our systematic review and meta-analysis found that occupational exposure to ergonomic risk factors is highly prevalent. The current body of evidence is, however, limited, especially by risk of bias and indirectness. Producing estimates for the burden of disease attributable to occupational exposure to ergonomic risk factors appears evidence-based, and the pooled effect estimates presented in this systematic review may perhaps be used as input data for the WHO/ILO Joint Estimates. Protocol identifier: https://doi.org/10.1016/j.envint.2018.09.053. PROSPERO registration number: CRD42018102631. © 2020 World Health Organization

Additional file 2. Reasons for excluding studies based on full text.

Purpose To examine the impact of rotator cuff calcific tendinitis on patients’ self-reported work ability and sick leave, to compare work ability and sick leave with shoulder function after minimally invasive treatment, and to assess which prognostic factors influence the change in work ability. Methods A prospective cohort was analyzed in this study. The primary outcome measure was the single-question work ability score (0-10 points). Secondary outcome measures were quality and quantity of work, sick leave, functional outcome, and radiographic resorption. Potential predictive factors (treatment method, age, sex, resorption of the calcific deposit, physical work load, and work status) were tested in a statistical model. Follow-up was at 6 months and 1 year. Results The study cohort consisted of 67 patients. The mean age was 49.6 ± 6.4 years and 45 (67%) were female. Physical workload was categorized as light (58%), medium (24%), and heavy (18%). Work ability score improved from a mean of 6.1 ± 2.8 to 8.5 ± 2.0 points after 1 year. Treatment with minimally invasive treatment techniques was associated with a reduction in partial or full-time sick leave from 28% to 6%. The mean days of sick leave a month declined from 3.3 to 0.8 days. Functional disability was greater in patients with partial or full-time sick leave. The physical workload turned out to be the most important patient associated factor predicting change in work ability. Conclusions This study supports the hypothesis that rotator cuff calcific tendinitis has a significant impact on work ability and sick leave. Minimally invasive treatment resulted in a clinically relevant improvement in work ability score and decline in sick leave. In particular, patients with medium and high physically demanding work for the shoulder benefit from minimally invasive treatment to improve their work ability. Level of Evidence Level II, prospective comparative study.

Evidence for recommendations concerning the resumption of activities of daily life, including work and sport, after knee arthroplasty is lacking. Therefore, recommendations vary considerably between hospitals and healthcare professionals. We aimed to obtain multidisciplinary consensus for such recommendations. Using a Delphi procedure, we strived to reach consensus among a multidisciplinary expert panel of six orthopaedic surgeons, three physical therapists, five occupational physicians and one physician assistant on recommendations regarding the resumption of 27 activities of daily life. The Delphi procedure involved three online questionnaire rounds and one face-to-face consensus meeting. In each of these four rounds, experts independently decided at what time daily life activities could feasibly and safely be resumed after knee arthroplasty. We distinguished patients with a fast, average and slow recovery. After four Delphi rounds, the expert panel reached consensus for all 27 activities. For example, experts agreed that total knee arthroplasty patients with a fast recovery could resume cycling six weeks after the surgery, while those with an average and slow recovery could resume this activity after nine and twelve weeks, respectively. The consensus recommendations will subsequently be integrated into an algorithm of a personalized m/eHealth portal to enhance recovery among knee arthroplasty patients.

Unicompartmental and total knee arthroplasty are well established treatment options, primarily aimed at reducing pain and improving joint function for patients with end-stage knee osteoarthritis.1 Although most patients receiving knee arthroplasty have good clinical outcomes, core outcome definitions suggest that societal participation after surgery is not a primary treatment goal.2 This is unfortunate as the number of patients receiving arthroplasty is rapidly increasing. In the Netherlands, a 297% growth in knee arthroplasties is expected between 2005 and 2030,3 with half of the patients of working age due the rising pension age and increasing trends in osteoarthritis among younger people. In particular for these ‘younger’ patients, societal participation including activities of daily life, sport and work is essential.4 In BMJ Open Sport & Exercise Medicine , Konings and colleagues5 reported on a systematic review on 19 studies (n=4074 participants) on physical activity and sports participation before and after knee arthroplasty. The authors found that knee arthroplasty, in general, has positive effects on physical activity and sports participation. Physical activity and sports participation return to levels similar to those before the osteoarthritis symptoms and is fortunately much higher compared with presurgery. Only high-impact sports were less frequently resumed after surgery. Furthermore, patients who remained active until the surgery were also most active after surgery, while patients who stopped participating in physical activities and sports prior to surgery were less likely to restart postsurgery. Physical activity is a …

BACKGROUND: Knee arthroplasty (KA) is increasingly performed in relatively young, active patients. This heterogeneous patient population often has high expectations, including work resumption and performance of knee-demanding leisure-time activities. Goal attainment scaling (GAS) may personalize rehabilitation by using patient-specific, activity-oriented rehabilitation goals. Since unmet expectations are a leading cause of dissatisfaction after KA, personalized rehabilitation may improve patient satisfaction. We hypothesized that, compared with standard rehabilitation, GAS-based rehabilitation would result in younger, active patients having higher satisfaction regarding activities after KA. METHODS: We performed a single-center randomized controlled trial. Eligible patients were

Total knee arthroplasty is increasingly performed on working-age individuals, but little is known about their recovery process. Therefore this study examined recovery courses of physical and mental impairments, activity limitations and participation restrictions among working-age total knee arthroplasty recipients. Associated sociodemographic and health-related factors were also evaluated. A prospective study among working total knee arthroplasty patients (aged n = 146). Surveys were completed preoperatively and 6 weeks and 3, 6, 12, and 24 months postoperatively. Outcomes represented domains of the International Classification of Functioning, that is, physical impairments (pain, stiffness, vitality), mental impairments (mental health, depressive symptoms), activity limitations (physical functioning), and participation restrictions (social-, work functioning, working hours). Covariates included age, gender, education, home situation, body mass index, and comorbidity. Largest improvements in physical and mental impairments and activity limitations were observed until 3 months postoperatively. Participation in social roles improved early after surgery, and improvements in work participation occurred from 6 to 12 months. Older age, being male and fewer comorbidities were associated with better recovery courses. Working-age total knee arthroplasty patients recover soon from physical and mental impairments, activity limitations, and participation in social roles, but participation at work occurs later. Younger patients, females, and those with musculoskeletal comorbidities appear at risk for suboptimal recovery after total knee arthroplasty.Implications for rehabilitationAn increasing number of working-age patients are asking for total knee arthroplasty and have high expectations of total knee arthroplasty, in particular, to participate in the workforce again;Recovery after total knee arthroplasty (TKA) does not occur in the short term and is not limited to clinical improvements for working-age TKA recipients only, as an important part of recovery, that is, participation occurs in the long term (>6 months);Closer collaboration between occupational physicians and orthopedic surgeons might result in increased and earlier ability to work full contractual hours;Rehabilitation after TKA should focus on patients with multiple comorbidities, whereby musculoskeletal diseases may even need additional preoperative treatment to optimize outcomes and prevent work disability. An increasing number of working-age patients are asking for total knee arthroplasty and have high expectations of total knee arthroplasty, in particular, to participate in the workforce again; Recovery after total knee arthroplasty (TKA) does not occur in the short term and is not limited to clinical improvements for working-age TKA recipients only, as an important part of recovery, that is, participation occurs in the long term (>6 months); Closer collaboration between occupational physicians and orthopedic surgeons might result in increased and earlier ability to work full contractual hours; Rehabilitation after TKA should focus on patients with multiple comorbidities, whereby musculoskeletal diseases may even need additional preoperative treatment to optimize outcomes and prevent work disability.

Knee joint distraction (KJD) is a novel technique for relatively young knee osteoarthritis (OA) patients. With KJD, an external distraction device creates temporary total absence of contact between cartilage surfaces, which results in pain relief and possibly limits the progression of knee OA. Recently, KJD showed similar clinical outcomes compared with high tibial osteotomy (HTO). Yet, no comparative data exist regarding return to sport (RTS) and return to work (RTW) after KJD. Therefore, our aim was to compare RTS and RTW between KJD and HTO. We performed a cross-sectional follow-up study in patients