The Impact of Waiting for Hip and Knee Arthroplasty in People of Working Age: An Evaluation of the Workforce Productivity and Macroeconomic Effects in Patients Under 65 Years

Hip and knee arthroplasty are increasingly performed in working-age individuals. This study assessed the effect of waiting for surgery on ability to work, return-to-work (RTW), and the associated economic impact. This retrospective cohort included patients aged ≤65 years who underwent total hip (THA) or total knee arthroplasty (TKA) between April 2023 and March 2025 at a UK orthopaedic national treatment centre. Participants completed outcome measures and a RTW questionnaire. Economic analysis incorporated national salary and productivity data. Of 92 patients, 73.9% RTW post-operatively, with higher rates in those aged <50 years (>90% RTW) and among THA recipients (85.1%) compared to TKA (62.2%). Median RTW time was 2.5 months; 67.6% required work modifications. Pre-operative work cessation (n=34) correlated with failure to RTW (p=0.004). Longer waits increased pre-operative work cessation but did not affect post-operative RTW rates. 4.3% of those waiting 3 months stopped work pre-operatively, rising to 28.3% at 12 months, and 33.7% at 24 months. A three-month wait corresponded to a mean pre-operative work cessation cost per patient of £1,496 compared to £9,724 for a 12 month wait, with this difference costing the Scottish economy over £44.5 million annually. Overall employment time-loss related to OA requiring arthroplasty in Scotland cost approximately £373 million annually. Most patients under 65 years RTW, often requiring temporary modifications. Younger age and THA were associated with higher RTW rates, while pre-operative work cessation predicted non-return. These findings demonstrate the substantial financial impact of OA on individuals and the wider economy, exacerbated by longer waiting times.