Abstract
BACKGROUND: There has been an increasing focus in recent years on health-care disparities. Studies investigating return to work (RTW) or sports are often performed in large, urban areas. Relatively few studies have investigated rates of return to farming or other heavy labor that is of interest to patients in rural areas. AIM: To evaluate the literature regarding RTW in farming or heavy labor after orthopedic hip, knee, or shoulder surgery. METHODS: A search was performed in the PubMed and EMBASE databases using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies were included if they reported patients employed in farming or heavy labor, RTW rates after orthopedic surgery of the hip, knee, or shoulder, and had a minimum 6-month follow-up. A meta-analysis of proportions using a random-effects model was performed on three single-arm observational studies to estimate the pooled RTW rate following arthroscopic shoulder surgery. RESULTS: Ten studies were included, and 101 farmers were identified among 440 total patients. One study involved hip surgery, two studies involved knee surgery, and seven studies involved shoulder surgery. RTW rates across studies varied by type of surgery and follow-up interval, ranging from 24% to 100%. The RTW rate was only 53.6% at 1 year following total hip arthroplasty. No studies investigated RTW in farmers following total knee arthroplasty. Among non-comparative studies, meta-analysis revealed a pooled RTW rate of 89% following arthroscopic shoulder surgery, with low heterogeneity (I (2) = 30.1%). Among comparative studies, one study reported significantly higher RTW odds for patients undergoing anatomic total shoulder arthroplasty compared to reverse shoulder arthroplasty (odds ratio = 5.45). Overall, surgical intervention for shoulder pathology was associated with a high likelihood of RTW across multiple techniques, with particularly favorable outcomes for anatomic total shoulder arthroplasty. CONCLUSION: This systematic review highlights the high rates of RTW in farmers and heavy laborers after shoulder surgery. However, our findings also underscore the need for more rural-specific research to guide patient counseling, rehabilitation expectations, and shared decision-making in this underserved population, particularly for orthopedic surgery of the hip and knee.