Abstract
PurposeThis prospective cohort study aimed to examine objective and subjective parameters in patients who underwent total knee replacement (TKR) to assess from when on driving a car can be deemed safe again.MethodsThirty patients (16 women, 14 men, age 66 ± 11 years) who received TKR of the right knee and 45 healthy controls (26 women, 19 men, age 32 ± 9 years) were asked to perform an emergency braking manoeuvre using a driving simulator. Brake pedal force (BPF), neuronal reaction time (NRT), brake reaction time (BRT), and subjective parameters (pain, subjective driving ability) were measured preoperatively as well as 5 days, 3–4, and 6 weeks after TKR.ResultsPreoperative NRT was 506 ± 162 ms, BRT 985 ± 356 ms, and BPF 614 ± 292 N. NRT increased to 561 ± 218 ms, BRT to 1091 ± 404 ms and BPF decreased to 411 ± 191 N 5 days after TKR. Three weeks after surgery, NRT was 581 ± 164 ms and BRT 1013 ± 260 ms, while BPF increased to 555 ± 200 N. Only BPF showed significant differences (p < 0.01). In week 6, all parameters were restored to baseline levels; patients showed significant pain decrease and evaluated their driving ability as “good” again.ConclusionBPF was the only parameter displaying a significant postoperative decrease. However, preoperative patients’ baseline levels and subjective confidence in driving ability were only reached 6 weeks after the operation. These results indicate that a minimum waiting period of 6 weeks should be considered before patients can safely participate in road traffic at their individual preoperative safety level again.Level of evidenceII.
Highlights
For many patients, driving a car is essential and grants them mobility, flexibility and independence and is usually compromised due to pain, use of walking aids and partial weight bearing after lower limb surgery
Pearson correlation test was performed comparing neuronal reaction time (NRT), brake reaction time (BRT) and brake pedal force (BPF) with the exact number of postoperative days within the 3rd and 4th measurement appointments in order to exclude any impact of chosen time ranges mentioned above
Subjective outcome parameters did not show satisfying results until 6 weeks after surgery. These results suggest that a timeframe of 6 weeks after total knee replacement (TKR) should be kept before patients can safely start driving again confirming our hypothesis
Summary
For many patients, driving a car is essential and grants them mobility, flexibility and independence and is usually compromised due to pain, use of walking aids and partial weight bearing after lower limb surgery. Patients, frequently inquire about recovery times and when they can safely drive again after total knee replacement (TKR). These questions typically remain unanswered as there are no standardised recommendations. Performing a sufficient emergency braking is one of the most relevant skills to drive a car safely [9, 18]. BPF is essential for performing sufficient emergency braking manoeuvres. No other study evaluates the ability of car driving as combination of reaction time, BPF and subjective outcome parameters following TKR. The purpose of this study was to investigate objective and subjective safety parameters after TKR to evaluate safe return to car driving. It was hypothesised that car driving ability will not be restored before 6th postoperative week
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