Orthopedic surgeons may feel like they are fumbling in the dark when it comes to worker’s compensation (WC) patients. Are they truly injured? What is the real problem? Shane J. Nho, M.D., M.S. is assistant professor and director of the Hip Preservation Center at Rush University Medical Center. He and several colleagues undertook a study with 29 WC patients who underwent hip arthroscopy. The goal? See if they could return to work postoperatively…without restrictions.
Workers Comp Patients, Hip Arthroscopy, and Return to Work
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Dr. Nho told OTW, “The worker’s compensation population tends to be challenging, whether it be a rotator cuff issue, a knee problem, or a hip injury. With an aging workforce, a lot of patients come in with chronic issues, and we must determine whether the work injury caused a substantial worsening of their condition. Another issue with these patients is that there are more parties involved than just the patient and doctor including the employer, attorneys, nurse case managers, and insurance adjusters. In some cases, the patients may end up getting treated for an incorrect diagnosis (i.e., low back pain), but the hip may actually be the underlying problem. Let’s presume someone has had back issues for a year; then they finally find the right provider. By that time, however, they have developed a host of other issues. Trying to figure out if there is an objective or structural problem versus referred pain versus secondary gain is difficult to discern.”
“The good news from our study is that the majority of patients in this group were able to return work in a timely fashion with no restrictions (69%). The workers who were more likely to return to work were treated within three months of injury versus over six months in those returned with impairment. Also, we found that those who were not able to return to work were more likely to have multiple orthopedic injuries and a higher BMI [body mass index].”
“The take home message is that hip arthroscopy in a workman’s compensation population should perform as well as a regular patient population provided that these patients are diagnosed and treated correctly and efficiently. So the longer it takes to diagnose the patient, the more body parts are affected and the less likely they are to be able to return to work.”
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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