Leeds Orthopaedic & Trauma Sciences, School of Medicine, University of Leeds, United Kingdom.
Bradford Royal Infirmary, United Kingdom.
Knee. 2021 Jun;30:214-240. doi: 10.1016/j.knee.2021.03.013. Epub 2021 May 1.
There is limited evidence available on return to driving for patients undergoing knee arthroplasty (KA). Primarily, surgeons have used brake reaction time as a surrogate measure of safe return to driving. The purpose of this study was to review existing literature and provide guidance on the recovery of braking performance following knee arthroplasty.
A literature search was performed for prospective studies on driving after KA. Two reviewers screened citations for inclusion, assessed methodological quality, and extracted data. Values for total brake reaction-time (TBRT), movement-time (MT), reaction-time (RT), and braking-force (BF) were included for meta-analysis.
Twelve studies with 368 subjects were identified. TBRT, RT, MT, and BF relative to preoperative baseline were assessed. Meta-analysis of TBRT showed a significant improvement from preoperative baseline at 3 months & 1 year (p = 0.003 & p = 0.0001). MT showed a significant increase at 2 and 4 weeks (p = 0.00001 & p = 0.03) before returning to no being significantly different at 6 weeks and beyond. In contrast RTs were noted to improve significantly 2 weeks (p = 0.006), 4 weeks (p = 0.03), and 1 year (p = 0.0002).
Meta-analysis showed no significant difference in TBRT up until 3 months. RT increased significantly post-operatively suggesting it is not a reliable indicator. MT in contrast was significantly decreased post KA and may represent a more reliable measure of braking performance post KA. Surgeons should consider these recommendations and other patient factors that determine fitness to drive prior to advising their patients on a safe to return to driving.
膝关节置换术后患者恢复驾驶的相关证据有限。主要是，外科医生使用制动反应时间作为安全恢复驾驶的替代指标。本研究的目的是回顾现有文献，并提供膝关节置换术后制动性能恢复的指导。
对膝关节置换术后驾驶的前瞻性研究进行文献检索。两名审查员筛选引文以纳入、评估方法学质量并提取数据。进行荟萃分析以纳入总制动反应时间（TBRT）、运动时间（MT）、反应时间（RT）和制动力（BF）的值。
确定了 12 项研究，共 368 例受试者。评估了 TBRT、RT、MT 和 BF 相对于术前基线的情况。TBRT 的荟萃分析显示，在术后 3 个月和 1 年时，与术前基线相比有显著改善（p=0.003 和 p=0.0001）。MT 在术后 2 周和 4 周（p=0.00001 和 p=0.03）时显著增加，在术后 6 周及以后则不再显著增加。相比之下，RT 在术后 2 周（p=0.006）、4 周（p=0.03）和 1 年（p=0.0002）时明显改善。
荟萃分析显示，在术后 3 个月内，TBRT 无显著差异。术后 RT 显著增加，提示其不是可靠的指标。相反，MT 在术后明显降低，可能是膝关节置换术后制动性能更可靠的指标。外科医生在建议患者安全恢复驾驶之前，应考虑这些建议以及其他决定患者是否适合驾驶的因素。
