Indiana University School of Medicine, Indianapolis, IN, USA.
Leeds Orthopaedic and Trauma Sciences, School of Medicine, University of Leeds, UK.
Hip Int. 2023 Jan;33(1):17-27. doi: 10.1177/1120700021998028. Epub 2021 Mar 18.
BACKGROUND/OBJECTIVE: Advice given to patients on driving resumption after total hip arthroplasty (THA) is inconsistent. Due to a lack of clear guidelines, surgeons' recommendations range between 4-8 weeks after surgery to resume driving. Delays in driving return can have detrimental social and economic impact. However, it is important to ensure patients only resume driving once safe. This study presents a systematic review and meta-analysis of driving simulation studies after THA to establish when patients can safely return to driving postoperatively.
A systematic review and meta-analysis using PRISMA guidelines was undertaken. Titles and abstracts were screened for inclusion, data was extracted, and studies assessed for bias risk. Review Manager, was used for statistical analysis. Values for brake reaction time (BRT) were included for meta-analysis.
14 articles met the inclusion criteria. Of these, 7 measured BRT and were included in the meta-analysis. Pooled means of both right and left THA showed BRT around or above preoperative baseline at 1 week, 2 weeks and 3 weeks, and below baseline at 6 weeks, 12 weeks, 32 weeks and 52 weeks. Of these, the pooled means at 6, 32, and 52 weeks were significant ( < 0.05).Studies not meeting meta-analysis inclusion criteria were included in a qualitative analysis, examining self-reported postoperative driving return times which ranged from 6 days to over a year or in rare cases, never. Majority of patients ( = 960) self-reported driving return within approximately 6 weeks (pooling of mean values 32.9 days).
The mean return to driving time recommended in the literature was 4.5 weeks. Based upon BRT meta-analysis, a return to baseline braking performance was noted at 6 weeks postoperatively. However, driving is a complex skill, and patient recommendation should be individualised based on factors such as vehicle transmission type, THA technique, surgical side, medication and comorbidities.
背景/目的：全髋关节置换术（THA）后患者关于恢复驾驶的建议不一致。由于缺乏明确的指导方针，外科医生的建议范围在手术后 4-8 周之间恢复驾驶。延迟恢复驾驶会产生有害的社会和经济影响。然而，重要的是要确保患者只有在安全的情况下才能恢复驾驶。本研究对 THA 后的驾驶模拟研究进行了系统评价和荟萃分析，以确定患者术后何时可以安全地恢复驾驶。
采用 PRISMA 指南进行系统评价和荟萃分析。筛选标题和摘要以纳入研究，提取数据并评估研究的偏倚风险。使用 Review Manager 进行统计分析。纳入了制动反应时间（BRT）的值进行荟萃分析。
符合纳入标准的文章有 14 篇。其中，有 7 篇测量了 BRT 并纳入了荟萃分析。右髋和左髋的汇总平均值在术后 1 周、2 周和 3 周时接近或高于术前基线，而在 6 周、12 周、32 周和 52 周时低于基线。其中，6、32 和 52 周的汇总平均值具有统计学意义（ < 0.05）。不符合荟萃分析纳入标准的研究纳入了定性分析，检查了术后恢复驾驶的自我报告时间，范围从 6 天到 1 年以上，或者在极少数情况下，从未恢复驾驶。大多数患者（ = 960）自我报告在大约 6 周内恢复驾驶（汇总平均值为 32.9 天）。
文献中推荐的平均恢复驾驶时间为 4.5 周。根据 BRT 荟萃分析，术后 6 周时恢复到基线制动性能。然而，驾驶是一项复杂的技能，患者的建议应根据车辆传动类型、THA 技术、手术侧、药物和合并症等因素个体化。
