Employment characteristics and job loss in patients awaiting surgery on the hip or knee.

AIMS To investigate the factors, including size of organisation, associated with job loss in patients awaiting surgery to the hip or knee joint. METHODS A questionnaire was mailed to 498 consecutive patients of working age listed at a district general hospital for major joint replacement, knee arthroscopy, or periacetabular osteotomy. Questions were asked about level of physical disability, duration of symptoms, employment circumstances at the time the joint problem began, and job changes since the onset of symptoms with their reasons. Analysis focused on those in work when their health problem began. Cox regression was used to examine risk factors for job loss related and unrelated to the joint problem, and results were summarised as adjusted hazard ratios (HRs) with 95% confidence intervals (95% CI). RESULTS Responses came from 370 (74%) of those mailed, including 278 who were in work when their joint problem began. Of these, 82 (30%) had left their original job mainly or partly because of their joint disorder. Such job loss was more common in those employed in small businesses (HR for <10 v > or =10 employees: 1.9, 95% CI 1.2-3.0) and those whose work involved standing for >2 hours per day (HR 2.7, 95% CI 1.2-6.1) No similar associations were found when jobs were left for other reasons. After adjustment for non-sedentary work the association with small business employment remained but was weaker (HR 1.5, 95% CI 0.9-2.5). Modifications to work and access to occupational health advice were not associated with better job retention. CONCLUSIONS In subjects with disabling hip or knee disease, job retention is poorer in those from small companies-a matter of concern given the rising prevalence of serious joint disease in the British workforce and the tendency of businesses to downsize and subcontract services to smaller enterprises.