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Richards JT, Slaven SE, Yow BG, Tracey RW, Mack AW, Cody JP. Rapid Return to Braking After Anterior and Posterior Approach Total Hip Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00008. [PMID: 38569087 PMCID: PMC10994538 DOI: 10.5435/jaaosglobal-d-23-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Little is known about the effect of surgical approach on return to braking after total hip arthroplasty (THA), and few studies have investigated braking after THA with modern surgical techniques and rehabilitation protocols. METHODS In a prospective comparative design, we enrolled 65 patients who received right-sided primary THA at our institution from April 2018 through March 2020, 34 with a direct anterior approach (DAA) and 31 with a posterior approach (PA). Braking tests measuring brake reaction time (BRT) and brake pedal depression (BPD) were administered to patients preoperatively and at 1, 2, and 4 weeks postoperatively using a realistic driving simulator. BRT and BPD were compared between groups and preoperatively versus postoperatively using mixed-effects models. RESULTS Preoperative BRT averaged 638 msec in the DAA group and 604 msec in the PA group (P = 0.31). At 1 week postoperatively, the DAA group had significantly prolonged BRT compared with preoperatively (694 msec, P = 0.02). No significant difference was observed in the PA group (633 msec, P = 0.31). Both groups had returned to baseline by 2 weeks, and both had significantly faster BRT at 4 weeks compared with preoperatively (583 msec for DAA, P = 0.01; 537 msec for PA, P < 0.001). BPD was similar between groups, and there were no significant differences between preoperative and postoperative BPD at any time point. CONCLUSIONS With modern surgical techniques, BRT after right-sided THA returns to baseline levels approximately 2 weeks after surgery. There seems to be a quicker return to preoperative BRT observed in patients with a PA.
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Affiliation(s)
- John T. Richards
- From the Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Sean E. Slaven
- From the Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Bobby G. Yow
- From the Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Robert W. Tracey
- From the Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Andrew W. Mack
- From the Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - John P. Cody
- From the Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
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Venugopal NK, O'Leary S, Robledo A, Husain A, Tom RB, Nuti SA, Jupiter DC, Panchbhavi VK. Safe driving recommendations following lower extremity orthopedic surgery: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:59-66. [PMID: 37639004 DOI: 10.1007/s00590-023-03705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE We analyzed the published literature on return-to-driving (RTD) recommendations following lower extremity orthopedic surgery, including knee and hip arthroplasty and ankle and foot surgery. METHODS We conducted a PubMed MEDLINE database search for the relevant literature spanning from 1988 to 2022. Data were extracted from the selected articles independently by six investigators, and the mean, standard deviation, and range of RTD recommendations for each surgical region and procedure were calculated. RESULTS The 34 studies included in our review evaluated brake response time, reaction time, movement time, braking force, and other parameters. Average RTD recommendations in weeks were: hip surgeries, 4.1 (± 2.7); foot surgeries, 6.67 (± 0.94); Achilles surgeries, 6.67 (± 0.25); ankle surgeries, 4 (± 2); knee surgeries, 5.42 (± 0.77); and multiple lower extremity surgeries, 3.85 (± 0.15). CONCLUSION Our findings can assist physicians in providing informed recommendations to patients, promoting safe driving practices, and optimizing postoperative recovery. LEVEL OF EVIDENCE Therapeutic, Level III: Retrospective comparative study.
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Affiliation(s)
- Navneet K Venugopal
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Sean O'Leary
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Ariadna Robledo
- Department of Neurosurgery, The University of Texas Medical Branch, 1005 Harborside Dr, Fifth Floor, Galveston, TX, 77555, USA
| | - Adam Husain
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Roshan B Tom
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Shiva A Nuti
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, 700 Harborside Drive, Ewing Hall 1.134, Galveston, TX, 77555-1148, USA
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
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Ratnasamy PP, Gouzoulis MJ, Kammien AJ, Oh I, Grauer JN. Home and Outpatient Physical Therapy Utilization Following Total Ankle Replacement. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221146175. [PMID: 36582653 PMCID: PMC9793015 DOI: 10.1177/24730114221146175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Physical therapy (PT) following total ankle replacement (TAR) is often considered, but guidelines for its use are not standardized. Although patient factors may dictate recommendations, this retrospective cohort study aims to characterize baseline utilization practices to set the stage for establishing generalizable recommendations. Methods TAR patients were identified from the 2010-2019 M91 Ortho PearlDiver data set based on administrative coding. Patient factors were extracted, including age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which patients' surgery was performed (Midwest, Northeast, South, West), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, and frequency of home or outpatient PT utilization in the 90 days following TAR were identified. Inpatient PT was not captured. Univariate and multivariate logistic regression analyses allowed identification of predictive factors for PT utilization. Results Of 5412 TAR patients identified, postoperative PT services were used by 2453 (45.3%). Most PT was outpatient (38.3% of the study population) compared to home (4.1% of the study population). Weekly utilization of PT was greatest in the first week following surgery (17.7% of PT visits) and thereafter followed a roughly bell-shaped curve, with utilization greatest at 7 weeks following surgery (14.9% of PT visits).Independent predictors of PT utilization following TAR included having surgery performed in the Midwest (relative to the South, OR 1.37, P < .0001), Northeast (OR 1.20, P = .0217), or West (OR 1.26, P < .0021) and having commercial (relative to Medicare, OR 1.87, P < .0001) or Medicaid insurance (OR 1.46, P = .0239). Conclusion Of 5412 TAR patients, 42.5% used PT within 90 days of surgery. PT utilization was highest in the first and seventh weeks following surgery, and demographic predictors of PT use were defined. Through identification of timing and predictors of PT utilization following TAR, PT care pathways may be better defined. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Philip P. Ratnasamy
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Michael J. Gouzoulis
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Alexander J. Kammien
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Irvin Oh
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N. Grauer
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
- Jonathan N. Grauer, MD, Department of
Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New
Haven, CT 06510, USA.
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Mazzotti A, Viglione V, Gerardi S, Bonelli S, Zielli S, Geraci G, Faldini C. Post-operative management after total ankle arthroplasty: A systematic review of the literature. Foot Ankle Surg 2022; 28:535-542. [PMID: 34088605 DOI: 10.1016/j.fas.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Currently, there is no consensus on the most appropriate post-operative management for patients undergoing total ankle arthroplasty. The aim of this study is therefore to offer a systematic review of the pertaining literature to identify current post-operative protocols and describe possible differences. METHODS A systematic review to identify recent studies concerning the post-operative management after total ankle arthroplasty was conducted. Five topics were analyzed: length of hospital stay, type and duration of immobilization, weight-bearing management, post-operative pharmacological therapies, adopted rehabilitation scheme. RESULTS Eighty-four studies met the inclusion criteria and were included in the review process. Most of the papers appear to have conflicting opinions with no consensus and homogeneous protocols. CONCLUSION Due to various methodological limitations, it is not possible to provide sufficiently supported evidence-based recommendations, and it is therefore difficult to determine the superiority of one post-operative protocol over the others after total ankle arthroplasty.
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Affiliation(s)
- A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - V Viglione
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Gerardi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Bonelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G Geraci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
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Frane N, Bandovic I, Hu V, Bitterman A. Return-to-Driving Recommendations After Lower-Extremity Orthopaedic Procedures. JBJS Rev 2021; 8:e20.00066. [PMID: 33298680 DOI: 10.2106/jbjs.rvw.20.00066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Following lower-extremity orthopaedic surgery, recommendations for safe return to driving include at least 6 to 12 weeks for a right ankle fracture, 2 days to 2 weeks for a right ankle arthroscopy, 6 to 9 weeks for a total ankle arthroplasty, 6 to 7 weeks for a right Achilles tendon rupture repair, 1 to 4 weeks for a right total knee arthroplasty, 2 weeks for a left total knee arthroplasty, 3 to 6 weeks for a right anterior cruciate ligament repair, and 1 to 4 weeks for a total hip arthroplasty. Important individual factors such as extent of injury, laterality of injury, current driving habits, type of vehicle transmission (manual or automatic), and medical comorbidities must be taken into consideration. State laws vary widely and often use vague language to describe the legal responsibilities that orthopaedic surgeons have when providing return-to-driving recommendations.
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Affiliation(s)
- Nicholas Frane
- Zucker School of Medicine at Hofstra/Northwell, Plainview, New York
| | - Ivan Bandovic
- NYIT College of Osteopathic Medicine, Old Westbury, New York
| | - Victor Hu
- NYIT College of Osteopathic Medicine, Old Westbury, New York
| | - Adam Bitterman
- Department of Orthopedic Surgery, Northwell Health Huntington Hospital, Huntington, New York
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Halai MM, Richards M, Daniels TR. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2021; 103:850-859. [PMID: 33784261 DOI: 10.2106/jbjs.21.00146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mansur M Halai
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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Salem HS, Park DH, Friedman JL, Jones SD, Bravman JT, McCarty EC, Frank RM. Return to Driving After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop J Sports Med 2021; 9:2325967120968556. [PMID: 33553439 PMCID: PMC7829529 DOI: 10.1177/2325967120968556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background Guidelines for return to driving after anterior cruciate ligament reconstruction (ACLR) have not been established. Purpose To review the literature pertaining to driving after ACLR and provide evidence-based guidelines to aid clinicians in counseling patients about driving after ACLR. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two independent reviewers searched PubMed, EMBASE, and the Cochrane Library using the terms anterior cruciate ligament, ACL, drive, and driving. Studies reporting on functional recovery after ACLR were included when data regarding return to driving were reported. Results Five studies were included. Two studies included patients who underwent right-sided ACLR. Of these, 1 study evaluated bone-patellar tendon-bone autograft and reported that brake response time (BRT) returned to normal approximately 4 to 6 weeks postoperatively. The other study found that BRT returned to normal 3 weeks after allograft ACLR, but 6 weeks elapsed after autograft ACLR before values were not significantly different than controls. One study reported that patients who underwent left-sided hamstring tendon autograft ACLR demonstrated BRTs similar to controls within 2 weeks, while those with right-sided ACLR had significantly slower BRTs until 6 weeks postoperatively. Another study including patients who underwent either right- or left-sided ACLR and employed a manual transmission simulator found that 4 to 6 weeks should elapse after ACLR with hamstring tendon autograft. Survey data from 1 study demonstrated that the mean time for patients to resume driving was 13 and 10 days after right- and left-sided ACLR, respectively. Conclusion BRT returned to normal values approximately 4 to 6 weeks after right-sided ACLR and approximately 2 to 3 weeks after left-sided ACLR. According to 1 study in this review, ACLR laterality should be disregarded for patients who drive manual transmission automobiles, as a 4- to 6-week time period was required for driving ability to reach the level of healthy controls. Future studies should aim to elucidate the influence of graft choice and transmission type on return to driving after ACLR.
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Affiliation(s)
- Hytham S Salem
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Do H Park
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jamie L Friedman
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steven D Jones
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan T Bravman
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rachel M Frank
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
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