Return to farming after orthopedic surgery: A systematic review

Table 1 Summary of included studies

Ref.	Design	Years of Study	Location	Inclusion/exclusion	Comparison groups	Patients per group	Follow-up	Outcomes	Study type
Gowd et al[13], 2019	Retrospective cohort	Not specified (mean follow-up 69 months)	United States	Patients undergoing hemiarthroplasty or aTSA for OA; excluded if incomplete follow-up	Hemi RR vs aTSA	Hemi RR: 25 (2 farmers) aTSA: 28	Mean 69 months	Return to heavy labor, ASES scores, satisfaction	Comparative; shoulder arthroplasty
Mihata et al[16], 2019	Retrospective case series	SCR cohort followed to 5 years	Japan	Patients with irreparable rotator cuff tears; excluded prior surgery or Goutallier > 3	None	30 (5 farmers in labor subgroup)	5 years	Return to work, shoulder function scores	Single-arm; SCR
Shimada et al[14], 2023	Retrospective cohort	2012-2017	Japan	Patients undergoing aTSA or RSA for OA; excluded if revision or incomplete data	aTSA vs RSA	aTSA: 64 (3 farmers) RSA: 68 (12 farmers)	Mean 3-4 years	Return to sport/work, ROM, satisfaction	Comparative; shoulder arthroplasty
Mihata et al[17], 2025	Retrospective case series	10-year follow-up study	Japan	Patients with irreparable rotator cuff tears undergoing SCR	None	36 (9 farmers)	10 years	Graft integrity, RTW, ASES scores	Single-arm; SCR
Carlson [11], 2005	Retrospective case series	1985-2002 (approximately)	United States	Posterior bicondylar tibial plateau fractures treated with ORIF	None	5 (1 farmer)	13 months average	Return to work, ROM, complications	Single-arm; ORIF
Pop et al[10], 2016	Retrospective survey	2003-2014	Poland	Patients with THA, rural background, working age, 10-year follow-up	None	32 (6 farmers)	10 years	Employment status, Harris Hip Score, health status	Single-arm; THA
Ohta et al[18], 2024	Retrospective cohort	Not stated	Japan	Patients undergoing ASCR for IRCT	Pseudoparalysis vs non-pseudoparalysis, and graft healed vs not	49 (2 farmers)	Minimum 2 years (mean approximately 34 months)	RTW, ROM, graft integrity, constant, JOA	Single-arm; SCR
Mihata et al[15], 2018	Retrospective cohort	Follow-up to 4 years	Japan	Patients undergoing SCR; outcomes stratified by physical activity	Heavy labors vs others	100 (9 farmers in heavy labor group)	4 years	RTW, sports, function scores	Single-arm; SCR
Green et al[19], 2022	Retrospective case series	2015-2019	United States	Manual laborers aged 50-60 years with full-thickness RCT, no workers’ comp	None	48 (3 farmers)	34 months average	RTW, time to return, SANE, ASES, VAS	Single-arm; RCR
Korovessis et al[12], 1999	Prospective cohort	1983-1985 surgeries; 5-12 years follow-up	Greece	Agricultural workers with medial OA	Mittelmeier vs AO closing wedge osteotomy	M: 35, AO: 28 (all farmers)	Mean 11 years	RTW, knee axis, satisfaction, TKA conversion	Comparative; HTO

aTSA: Anatomic total shoulder arthroplasty; OA: Osteoarthritis; ASES: American shoulder and elbow surgeons; SCR: Superior capsule reconstruction; RSA: Reverse shoulder arthroplasty; ROM: Range of motion; RTW: Return to work; ORIF: Open reduction and internal fixation; THA: Total hip arthroplasty; ASCR: Arthroscopic superior capsular reconstruction; IRCT: Irreparable rotator cuff tear; JOA: Japanese Orthopaedic Association; RCT: Rotator cuff tear; SANE: Single assessment numeric evaluation; RCR: Rotator cuff repair; VAS: Visual analogue scale; AO: Association for the Study of Internal Fixation; M: Mittelmeier closing osteotomy; TKA: Total knee arthroplasty; HTO: High tibial osteotomy.

Table 2 Methodological index for non-randomized studies criteria of the included studies

MINORS criterion	Korovessis et al[12], 1999	Carlson [11], 2005	Pop et al[10], 2016	Mihata et al[15], 2018	Gowd et al[13], 2019	Mihata et al[16], 2019	Shimada et al[14], 2023	Ohta et al[18], 2024	Mihata et al[17], 2025	Green et al[19], 2022
Cleary stated aim	2	2	2	2	2	2	2	2	2	2
Inclusion of consecutive patients	1	1	1	2	1	2	2	1	2	1
Prospective collection of data	2	0	0	1	1	1	1	0	2	1
Endpoints appropriate to the aim of the study	2	2	2	2	2	2	2	2	2	2
Unbiased assessment of the study endpoint	1	1	1	1	2	1	1	2	1	1
Follow-up period appropriate to the arm of the study	2	1	1	2	2	2	2	2	2	2
Loss to follow-up < 5%	1	1	0	2	1	1	1	1	0	2
Prospective calculation of the study size	0	-	-	0	0	-	0	0	-	-
Adequate control group	2	-	-	2	2	-	2	2	-	-
Contemporary groups	2	-	-	2	2	-	2	2	-	-
Baseline equivalence of groups	1	-	-	1	2	-	1	2	-	-
Adequate statistical analyses	1	-	-	2	2	-	2	2	-	-
Total score	17	8	8	19	19	11	18	18	11	11

MINORS: Methodological index for non-randomized studies.