Abstract
Aim The purpose of this study is to systematically review patient characteristics and clinical determinants that may influence return to driving status and time frames following a primary TKA or THA and provide an update of the current literature. Methods This review was completed per the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Final electronic database searches were completed in October 2019 in Medline/PubMed, Medline/OVID, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library using preselected search terms. Manuscripts of prospective and nonrandomized studies that examined the return to driving a car after a primary knee or hip arthroplasty patients were included. The Methodological Index for Non-Randomized Studies was used to measure study quality. Two authors selected studies and assessed their qualities. All disagreements were resolved through discussion and, as needed, a third reviewer. Data on study title, author(s), country, year, study design, sample size, inclusion and exclusion criteria, age, BMI, gender, statistical analyses, driving measure, follow-up time, surgical approach, laterality, and postoperative management were extracted from each study. Results A total of 23 studies were eligible, including 12 TKA studies (n = 654) with mean ages between 43 and 82 years, 9 THA studies (n = 922) with mean ages between 34 and 85 years, and 2 combined TKA and THA (TKA, n = 815; THA, n = 685), yielded MINORS scores between 6 and 12. Most patients achieved or exceeded preoperative response times between 1 and 8 weeks following a TKA and 2 days to 8 weeks following a THA, and/or self-reported return to driving between 1 week and 6 months. Influences on return to driving time included laterality and pain, but gender was mixed. Discussion/Conclusions Study results were consistent with previous systematic reviews in that return to driving a car after a primary TKA or THA is highly variable, and most commonly occurs around 4 weeks, but can range between 2 and 8 weeks. While various patient and clinical factors can influence return to driving for a TKA or THA, the most common contributing facts were pain and laterality. The heterogeneous nature of the studies prevented a meta-analysis for determining contributions of return to driving following a primary TKA or THA. Regardless, this study updates previous systematic reviews and presents insight on patient and clinical factors beyond generalized timeframes for return to driving a car. This information and results from future studies are essential to guide clinical recommendations and patient and clinician expectations for return to driving a car after a primary TKA or THA.
Highlights
The incidence of primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) as treatment of severe osteoarthritis (OA) is increasing due to the aging population [1].The USA prevalence of knee OA increased from 14% at age of 25-60 years to 37% at age of 60 years and older [2]
One study was excluded for not having a quantifying measure for return to driving, one study was not in English, one study was on knee osteoarthritis and not TKA, and one study was on unicompartmental TKA
Previous systematic reviews report that return to driving based on predetermined surrogate measures occurs at approximately 4 weeks after a right TKA in countries of right-sided driving [7, 8]
Summary
The incidence of primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) as treatment of severe osteoarthritis (OA) is increasing due to the aging population [1].The USA prevalence of knee OA increased from 14% at age of 25-60 years to 37% at age of 60 years and older [2]. The incidence of primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) as treatment of severe osteoarthritis (OA) is increasing due to the aging population [1]. In the 1970s, TKA rates trended at 31.2 per 100,000 personyears and THAs at 50.2. 30 years later, in the 2000s, TKAs increased to 220.0 per 100,000 personyears while THAs increased to 145.5 [3]. Much of the TKA and THA growth in patients with severe OA can be attributed to the advancement in technology and notable postoperative rehabilitation improvements [4]. Despite surgical and recovery success, the independence and quality of life of patients receiving a TKA or THA could be attenuated if their return to driving a car is delayed [5]
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