Franz A, Mannel H, Brüggemann G-P, Schmidt J
Orthopädische Klinik, Marienstift Arnstadt.
Z Orthop Unfall. 2012 Oct;150(5):533-8. doi: 10.1055/s-0032-1315245. Epub 2012 Oct 17.
Driving a car is an important everyday activity. However, the patients' desire to resume driving at an early stage after hip arthroplasty is often faced by the uncertainty about their driving ability. Only little evidence is available to support the clinical decision-making with regard to driving competence after conventional total hip arthroplasty (THA). However, there is no proof that the results observed after THA can be transferred to hip resurfacing arthroplasty (HRA) patients. Due to physiological advantages, i.e., patient age and activity, as well as the special biomechanical implant characteristics, HRA patients could be expected to achieve normal braking capacity at an earlier stage in the rehabilitation process than THA patients. This could be achieved by an accelerated postoperative recovery or could depend on the preoperative vantage point concerning the patients' braking capacity.
To verify this hypothesis HRA and THA patients were compared to healthy subjects concerning their ability to perform an emergency braking manoeuvre in a car simulator before surgery, and at 6 weeks and 3 months after operation. Furthermore, postoperative recovery rates were compared between the two groups of patients. In addition, correlations between pre- and postoperative braking capacity were tested. Reaction time, movement time and force-time integral on the brake pedal were analysed.
Except for a deficient preoperative force-time integral, no significant differences were detected in HRA patients compared to healthy controls. In contrast THA patients required, pre- as well as postoperatively, a longer movement time and exhibited a smaller force-time integral. The two patient groups did not show any significant difference in recovery rates of movement time and force-time integral. However, considering the two patient groups as a whole, a significant correlation was detected between existing pre- and postoperative deficits.
In conclusion, it can be confirmed that HRA patients resume normal braking capacity at an earlier stage in their rehabilitation process than THA patients. Patients recommended for HRA recover braking capacity at the latest six weeks after surgery. This capacity clearly depends on the better preoperative status of the HRA patients and is not determined by a faster recovery rate. General patient-related advantages as well as biomechanical aspects of HRA have thus no influence on the recovery rates of braking capacity during the first three months after surgery. Due to the increasing outpatient rehabilitation regime after HRA, further studies are necessary to detect the turning point after surgical impairment within the first six weeks after surgery. Concerning the THA patients we recommend a longer safety distance when driving a car for up to three months after the operation. However, patients, especially those assigned to THA, should be made aware of their most likely already existing preoperative deficit. For clinical practice a rough estimation of postoperative braking capacity seems to be possible based on group assignment (HRA/THA). Nevertheless, deviators cannot be detected by this group classification. As driving simulator systems usually are not available in hospitals, a more accurate prognosis, i.e., based on established clinical scores, would be helpful.
驾驶汽车是一项重要的日常活动。然而，髋关节置换术后患者早期恢复驾驶的愿望常常面临其驾驶能力不确定性的问题。关于传统全髋关节置换术（THA）后驾驶能力的临床决策，仅有少量证据可供支持。然而，尚无证据表明THA术后观察到的结果可应用于髋关节表面置换术（HRA）患者。由于生理优势，即患者年龄和活动情况，以及特殊的生物力学植入物特性，预计HRA患者在康复过程中比THA患者能更早达到正常制动能力。这可能通过术后恢复加速实现，也可能取决于患者制动能力的术前优势。
为验证这一假设，将HRA和THA患者与健康受试者在手术前、术后6周和3个月时在汽车模拟器中进行紧急制动操作的能力进行比较。此外，还比较了两组患者的术后恢复率。另外，测试了术前和术后制动能力之间的相关性。分析了制动踏板上的反应时间、动作时间和力 - 时间积分。
除术前力 - 时间积分不足外，与健康对照组相比，HRA患者未检测到显著差异。相比之下，THA患者术前和术后都需要更长的动作时间，且力 - 时间积分较小。两组患者在动作时间和力 - 时间积分的恢复率上没有显著差异。然而，将两组患者作为一个整体考虑时，术前和术后的现有缺陷之间存在显著相关性。
总之，可以确认HRA患者在康复过程中比THA患者更早恢复正常制动能力。建议进行HRA的患者在术后最迟六周恢复制动能力。这种能力显然取决于HRA患者更好的术前状态，而非更快的恢复率。因此，一般患者相关优势以及HRA的生物力学方面对术后前三个月制动能力的恢复率没有影响。由于HRA术后门诊康复方案的增加，有必要进行进一步研究以确定术后六周内手术损伤后的转折点。关于THA患者，我们建议术后三个月内驾驶汽车时保持更长的安全距离。然而，患者，尤其是接受THA的患者，应意识到他们术前很可能已经存在的缺陷。对于临床实践，基于分组（HRA/THA）对术后制动能力进行大致估计似乎是可行的。然而，通过这种分组分类无法检测到偏差者。由于医院通常没有驾驶模拟器系统，基于既定临床评分的更准确预后将有所帮助。
