Effect of total hip arthroplasty on brake reaction time and braking force

Predictive Factors for Return to Driving After Lower Limb Arthroplasty

Background

A common question post total hip arthroplasty (THA)/total knee arthroplasty (TKA) arthroplasty is "Doctor, when can I drive?". No objective assessment currently exists. This study aimed to identify clinical factors predicting driving return post hip THA and TKA.

Methods

In this single-center retrospective observational study, patients were reviewed at 6 weeks post THA and TKA. Patient demographics, driving status, timed up and go (TUG) test, self-reported walking time (SRWT), walking aid use, and pain scores were collected. Descriptive statistics, t-tests, and binary regression models were used.

Results

Five hundred ninety two participants were included: 271 THA (males n = 134, mean age: 66.4) and 321 TKA (males n = 155, mean age: 66.8). THA: At 6 weeks, 155 patients (57.1%) were driving and 116 did not drive (DND) (n = 82 female, 70.6%) (P < .001). SRWT was longer in driving group (mean 36.35 minutes vs 31.23 minutes [P = .072]). TUG tests were faster in driving group (9.51 seconds vs 11.98 seconds [P < .001]). Driving inability predictors included using 2 crutches (P < .001) and TUG (P = .015). TKA: At 6 weeks, 196 patients (61%) were driving and 125 DND (n = 78 female, 62.4%) (P < .01). SRWT was longer in driving group (mean 33.6 vs 28.1 minutes [P = .31]). TUG tests were faster in driving group (10.18 seconds vs 12.29 seconds [P < .001]). Driving inability predictors included "severe" pain scores (P ≤ .0001) and >2 walking aids use (P = .022).

Conclusions

Following THA/TKA, 60% patients were driving by 6 weeks. Females take longer for driving return. Walking aids negatively impacted driving return, while faster TUG test and longer SRWT were positive predictors.

The Relationship Between Driving Performance and Lower Limb Motor Function After Total Knee Arthroplasty Using a Driving Simulator: A Pilot Study on Elucidating Factors Influencing Accelerator and Brake Operations

BACKGROUND

The aging population in Japan has led to an increase in traffic accidents involving elderly drivers, highlighting the need for measures to enhance driving safety. Post-total knee arthroplasty (TKA) patients must regain their driving ability to maintain independence; however, clear guidelines for driving resumption are lacking. This study assessed the movement time (MT) and brake pedal force (BPF) using a driving simulator and investigated their associations with lower limb motor function.

METHODS

This single-center prospective cohort study included 21 patients (mean age: 66.7 ± 7.4 years) who underwent right TKA and intended to resume driving. Driving ability was assessed on postoperative day 13 using a driving simulator to measure MT and BPF. Physical function was evaluated using the following parameters: range of motion (ROM), muscle strength, gait parameters, and pain assessment. Pearson's correlation and multiple regression analyses were performed to identify significant associations.

RESULTS

MT was significantly correlated with knee extension strength (r = -0.56, p = 0.02) and walking ratio (r = 0.55, p = 0.03). BPF was significantly correlated with walking ratio (r = 0.52, p = 0.04) and pain levels VAS (r = -0.54, p = 0.02). Multiple regression analysis identified walking ratio (β = 0.54, p = 0.02) as a significant predictor of MT. For BPF, significant predictors included walking ratio (β = 0.49, p = 0.03) and VAS (β = -0.54, p = 0.02).

DISCUSSION

The findings of this study suggest that MT is associated with walking ratio, while BPF is significantly associated with both walking ratio and VAS scores. In particular, walking ratio was found to have a significant impact on both MT and BPF, indicating that it may be an important factor influencing postoperative driving performance.

CONCLUSION

Improvement in the walking ratio and pain management affect accelerator and brake operation during driving after TKA.

Factors That Influence Returning to Driving Following Primary Total Knee Arthroplasty: A Prospective Investigation

BACKGROUND

It is unclear when a patient can return to driving after total knee arthroplasty (TKA). Currently, most surgeons simply restrict all patients from driving for 4 to 6 weeks after TKA despite variability in patient age, general health, and physical capabilities. The primary objective of this study was to create novel clinical prediction calculators to estimate the return-to-driving time following primary TKA.

METHODS

In this study, 167 patients who were undergoing a primary TKA were prospectively enrolled. Subjects received text message surveys every third day postoperatively to determine when they returned to driving. Subjects completed 8 physical performance maneuvers at their 2, 6, and 12-week postoperative clinical appointments. Additionally, subjects completed return-to-driving surveys and a structured interview. Data on demographic characteristics, operative factors, patient-reported outcomes, and patient factors were collected. Cox proportional hazard and parametric survival models were utilized to create 2 novel calculators for predicting return-to-driving time.

RESULTS

There were 156 patients (mean age, 67.7 years [range, 39 to 83 years]) who completed the study. The median return-to-driving time was 18 days (interquartile range [IQR], 12 to 27 days). Univariate analysis demonstrated that male patients returned to driving sooner (18 days) than female patients (25.3 days) (p < 0.001) and that patients who underwent left-sided surgery returned to driving sooner (20.1 days) than patients who underwent right-sided surgery (24.4 days) (p = 0.021). For preoperative factors, age, sex, laterality, and preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) had an effect on return-to-driving time and therefore were included in the novel preoperative clinical prediction calculator. For postoperative factors, age, sex, laterality, preoperative KOOS, and 6 metrics from the physical performance maneuvers had an effect on return-to-driving time and therefore were included in the novel postoperative physical performance-based instrument.

CONCLUSIONS

Overall, patients undergoing primary TKA returned to driving considerably earlier than previously reported. Patient-related factors and postoperative physical performance significantly affect return-to-driving time. Using the novel preoperative clinical prediction tool, individual patients can be advised when to expect to return to driving. After surgery, the novel postoperative physical performance-based instrument can inform patients when they may be ready to return to driving.

LEVEL OF EVIDENCE

Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Rapid Return to Braking After Anterior and Posterior Approach Total Hip Arthroplasty

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.

Are brake response times altered post CT-guided cervical spine nerve root injections?

OBJECTIVES

To assess if brake response times are altered pre and post CT-guided cervical spine nerve root injections.

METHODS

Brake response times were assessed before and after CT-guided cervical spine nerve root injections in a cohort of patients. The average of 3 brake response times was recorded before and 30 min after injection. Statistical analysis was performed using GraphPad. A paired Student t-test was used to compare the times before and after the injections.

RESULTS

Forty patients were included in this study. The mean age was 55 years. There were 17 male and 23 female patients. There was no significant difference in the mean pre and post CT-guided cervical spine nerve root injection brake response times; 0.94 s (range 0.4-1.2 s) and 0.93 s (range 0.5-1.25 s), respectively (P = .77).

CONCLUSIONS

Brake response time did not significantly differ pre and 30 min post CT-guided cervical spine nerve root injections.

ADVANCES IN KNOWLEDGE

To the authors' best knowledge, there are no current studies assessing brake response times post CT-guided cervical spine nerve root injections. While driving safety cannot be proven by a single metric, it is a useful study in demonstrating that this is not inhibited in a cohort of patients.

Return to Driving After Hip Arthroscopy: A Systematic Review and Meta-analysis

Background:

Hip arthroscopy is an increasingly common procedure; however, recommendations for safely returning to driving after hip arthroscopy vary among surgeons.

Purpose:

To systematically review and analyze the current available evidence on the optimal time to safely return to driving after hip arthroscopy.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

A systematic review and meta-analysis was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two authors independently conducted a literature search throughout August 2021 using the PubMed, Google Scholar, Embase, and Cochrane databases. A total of 1425 articles were reviewed, and 5 articles were included. All included articles used brake reaction time (BRT) as an observer-reported outcome measure. A meta-analysis was performed to compare pre- and postoperative BRT values. Study sample sizes and mean BRT values were collected per each included study. First, data were analyzed for the right and left hips combined; then, a subgroup analysis stratified by laterality was performed. The BRT values were divided according to time periods of measurement: preoperatively and 2, 4, 6, and 8 weeks postoperatively.

Results:

The included studies evaluated safety to return to driving after hip arthroscopy in 160 patients. Of these, 142 patients were treated for femoroacetabular impingement, while 18 patients underwent hip arthroscopy for other diagnoses. The mean weighted age was 33.7 ± 9.0 years, 47.5% of the patients were female, and the right hip was affected in 71.2%. The preoperative range of BRT was 566 to 1960 ms, and postoperative BRT range was 567 to 1840 ms at 1 to 2 weeks and 523 to 1860 ms at 3 to 12 weeks. Meta-analysis found the studies to be moderately heterogenic ( P = .06). There were no statistically significant differences in BRT between the preoperative period and at 2, 4, 6, and 8 weeks postoperatively.

Conclusion:

Return to driving is likely safe as early as 2 to 4 weeks after right-sided hip arthroscopy, and 2 weeks after a left-sided procedure, as driving performance returns to the preoperative level.

Registration:

CRD42021274460 (PROSPERO identifier).