Center for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Department of Orthopedics, RKU University Hospital Ulm, Ulm, Germany.
Knee Surg Sports Traumatol Arthrosc. 2021 Oct;29(10):3213-3220. doi: 10.1007/s00167-020-06105-2. Epub 2020 Jun 24.
This 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.
Thirty 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.
Preoperative 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.
BPF 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.
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本前瞻性队列研究旨在评估接受全膝关节置换术（TKR）的患者的客观和主观参数，以确定何时可以再次安全驾驶汽车。
30 名接受右膝关节 TKR 的患者（16 名女性，14 名男性，年龄 66±11 岁）和 45 名健康对照者（26 名女性，19 名男性，年龄 32±9 岁）被要求使用驾驶模拟器进行紧急制动操作。在术前以及 TKR 后 5 天、3-4 周和 6 周时，测量制动踏板力（BPF）、神经元反应时间（NRT）、制动反应时间（BRT）和主观参数（疼痛、主观驾驶能力）。
术前 NRT 为 506±162ms、BRT 为 985±356ms、BPF 为 614±292N。术后 5 天，NRT 增加至 561±218ms、BRT 增加至 1091±404ms，BPF 降低至 411±191N。术后 3 周，NRT 为 581±164ms，BRT 为 1013±260ms，BPF 增加至 555±200N。只有 BPF 显示出显著差异（p<0.01）。在第 6 周，所有参数均恢复至基线水平；患者疼痛明显减轻，并再次评价其驾驶能力为“良好”。
BPF 是唯一显示术后显著下降的参数。然而，术前患者的基线水平和对驾驶能力的主观信心仅在术后 6 周后才能达到。这些结果表明，患者应至少等待 6 周才能再次以其术前的个人安全水平安全参与道路交通。
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