Total knee arthroplasty is an effective intervention for people with osteoarthritis. However, 15 to 30% of patients do not return to work, and studies frequently fail to provide an explanation of what may lead to work disability from workers’ perspectives of the biopsychosocial factors. This study aimed to document workers’ representations or understanding of work disability after total knee arthroplasty.

We adopted a qualitative approach with a narrative inquiry method. A convenience sample of partially and fully disabled workers was interviewed 6 to 12months after surgery with use of a semi-structured interview guide and questionnaires on physical work demands and pain. Interviews were audiotaped, transcribed verbatim, and anonymized. Consensus was reached on coding, and multidisciplinary content analysis was performed.

Among the 8 workers interviewed, all were formally employed before surgery, half were men, and the mean age was 55years. Half were not back at work when interviewed and felt they had received little support from their workplace, were struggling to adapt to their new condition, and had very few adaptive strategies for trying to get better (other than waiting), which did not make sense to them. By contrast, the other half felt they had experienced greater improvement after surgery and received concrete support from their workplace, which facilitated their return to work in their view.

A work disability paradigm, based on a biopsychosocial approach, should be considered in rehabilitation when workers experience difficulty returning to work after total knee arthroplasty, because other factors besides the patient's condition may be involved.