Elsevier

The Knee

Volume 15, Issue 4, August 2008, Pages 295-298
The Knee

Does the brake response time of the right leg change after left total knee arthroplasty? A prospective study

https://doi.org/10.1016/j.knee.2008.02.008Get rights and content

Abstract

Patients undergoing total knee arthroplasty often ask when they can safely resume car driving. There is little evidence available on which physicians can rely when advising patients on this issue. In a prospective study we assessed the brake response time of 24 patients admitted to the clinic for left total knee arthroplasty preoperatively and then 10 days after surgery. On each measurement day the patients performed two tasks, a simple and a complex brake response time task in a car simulator. Ten days after left TKA the brake response time for the simple task had decreased by 3.6% (p = 0.24), the reaction time by 3.1% (p = 0.34) and the movement time by 6.6% (p = 0.07). However, the performance improvement was not statistically significant. Task complexity increased brake response time at both time points. A 5.8% increase was significant (p = 0.01) at 10 days after surgery. Based on our results, we suggest that patients who have undergone left total knee arthroplasty may resume car driving 10 days after surgery as long as they drive a car with automatic transmission.

Introduction

Total knee arthroplasty reduces pain, enhances function, and improves the health-related quality of life in individuals with knee impairment and disability secondary to osteoarthritis or rheumatoid arthritis [1], [2], [3]. After surgery, patients often ask their physicians when they can safely start driving again. An early return to car driving can obviously improve mobility in daily activities during the first stages of the rehabilitation process, reducing dependency and social isolation.

Driving is a complex activity involving cognitive and motor skills. In traffic accident prevention research, the brake response time has been used as an adequate expression of drivers' psychomotor performance [4], [5], [6]. Many factors influence brake response time, e.g. ergonomic factors in the car such as the pedal layout, [7], [8] human factors such as age [9] or vision, [10], [11], [12] and environmental factors such as the type of brake lights [13].

There is little evidence available on which physicians can rely when advising patients about when they can safely resume car driving after TKA. With a computerized systematic literature search performed on Pubmed, Embase and Science Direct, two studies [14], [15] focusing on this topic were identified. The limitations of the literature concerning the time period that patients should wait before resuming driving after left total knee arthroplasty are (1) the small sample sizes (left TKA n = 6 [14], [15]), (2) the time that has elapsed before the first postoperative measurement (four [14] and three [15] weeks after surgery) and, (3) the results: in the first study [14] no differences were reported between preoperative brake response time values and those measured four weeks after surgery for the patients in the left TKA group, in the second study [15] the side on which surgery was performed was not taken into consideration regarding the effect on brake response time – all patients were considered as one group, i.e. patients who had undergone left TKA received the same recommendation as patients after right TKA.

The objective of the current study was to investigate the effects of left TKA on the brake response time of the right leg 10 days after surgery. An extension of this objective was then to determine whether an increase in task complexity would increase the brake response time. We hypothesized that there would be no differences between the mean brake response time, reaction time and movement time values before and 10 days after left TKA, and that an increase in task complexity would increase reaction time and therefore also increase brake response time.

Section snippets

Materials and methods

To determine the effects of left TKA on brake response time of the right leg a prospective study with a repeated-measures design was used. The components of brake response time (reaction time and movement time) were assessed in a car simulator. The measurements took place one day before surgery (the admission day) and 10 days after surgery (the day the patients left the clinic).

On the day of admission, the patients were informed about the study and asked to participate. All patients who agreed

Results

The data of 24 patients (13 men, 11 women) who underwent left TKA were pooled for analysis. The mean age of the patients in the sample was 63.2 ± 8.5 years. The sample demographic data is presented in Table 1.

The results of our hypothesis testing are presented in Table 2. Ten days after primary left TKA there were no statistically significant differences between the preoperative mean brake response time, reaction time and movement time values and the values measured 10 days after surgery in both

Discussion

In the present study we compared preoperative and postoperative brake response time, reaction time and movement time values of 24 patients undergoing primary left TKA in order to find out whether left TKA has negative effects on the brake response time of the right leg 10 days after surgery. For organizational reasons, during the patient recruitment period, we could not inform all patients admitted for left TKA about the study. Also the fact that a great percentage of the patients were not

Conclusions

Driving is a complex activity involving perceptual, decision-making, reaction and movement skills. The results of this study show that brake response time, reaction time and movement time were not affected ten days after left TKA. Task complexity increased reaction time and consequently brake response time. Our results suggest that patients who have undergone left total knee arthroplasty may be able to resume car driving 10 days after surgery.

Acknowledgments

We thank Klaus Rippe, of the Technical Department at the ENDO-Klinik, for the design of the car simulator; and Alexander Greiner, PT; Ulrike Tillmann, PT; Veito Kaul, PT; and Inken Hansen, PT, of the Physical Therapy and Rehabilitation Department at the ENDO-Klinik for their invaluable assistance.

We also thank the Foundation “ENDO-Verein Gemeinnütziger Förderverein der ENDO-Stiftung e.V.” for the funds granted to cover the costs related to the equipment used.

References (19)

There are more references available in the full text version of this article.

Cited by (41)

  • Break Reaction Time after Conservatively Treated Ligament Ruptures of the Ankle

    2021, Injury
    Citation Excerpt :

    Previous literature does not answer the question: At what time after ankle sprain injury can a patient safely participate in traffic? Studies have analyzed BRT after arthroplasty [7,8,12,22–25], knee arthroscopy [10,11] and spinal surgery [13,26], but not after ligament lesions of the ankle. Literature addressing trauma of the lower extremities have mainly evaluated patients with fractures [27–29].

  • Doctor when can I drive? Braking response after knee arthroplasty: A systematic review & meta-analysis of brake reaction time

    2021, Knee
    Citation Excerpt :

    This brings into question whether TBRT alone is a valid measure in determining when it is safe for a patient to return to driving. Seven of the included studies measured MT which appeared to be a more discerning measure of braking performance post KA if we consider that there appeared to be an adaptive or “learning” effect to the stimulus represented by the improvement in RT post-operatively [8,9,12,13,15,17,18]. The RT are likely to have improved due to drivers anticipating the signal.

  • Reaction Time and Brake Pedal Depression Following Arthroscopic Hip Surgery: A Prospective Case-Control Study

    2018, Arthroscopy - Journal of Arthroscopic and Related Surgery
    Citation Excerpt :

    Similar to this study, most prior works compare patients' reaction times following surgery or injury to preoperative baselines. Studies have examined BRT after anterior cruciate ligament reconstruction,8,9,16 total knee arthroplasty,3,4,17-21 total hip arthroplasty,5,22 unicondylar knee arthroplasty,23 first metatarsophalangeal joint fusion,24 tibiotalar fusion,25 lower extremity fracture,6,7 and ankle arthroscopy,26 with variable times taken to return to preoperative baselines. In addition, other groups have examined the effect of osteoarthritis,27 the use of spine, knee, hip, and ankle orthoses,10,28-30 and various lower extremity immobilization devices.31-33

  • Driving After Microinvasive Total Hip Arthroplasty

    2017, Journal of Arthroplasty
    Citation Excerpt :

    Ability to drive is a complex task to perform and assess. Given the function of the lower limbs in mobilizing into and out of vehicles as well as using accelerator and brake pedals, other studies investigating this following hip [11-14] and knee [19-23] arthroplasty have focused on BRT as a measure of ability to drive following surgery. Guidelines on normal BRT have a wide range across the world, varying from 0.7-1.5 s [10].

View all citing articles on Scopus
View full text