Abstract
Introduction: Osteoarthritis is the most common form of arthritis in the western world. With its increasing prevalence, total joint replacement is in high demand. After total hip replacement (THR) and total knee replacement (TKR) a period of driving cessation is necessary. For many patients, a period of driving cessation creates financial stress and threatens independence. The current recommendation for driving cessation following THR or TKR surgery is 6 weeks, however the literature surrounding this is varied.
Aims: To measure the average time it takes for a patient following either a THR or TKR to return to operating a motor vehicle safely; based on recovery of their pre-operative baseline transfer time to within 10%.
Methods: The transfer time from accelerator to a brake force of 100N (transfer time) was measured on a custom built rig. Patients were tested pre-operatively, and 1, 2, 4, and 6 weeks post-operatively The time in weeks was measured to return to within 10% of their pre-operative transfer time. A quantitative questionnaire was used at each test to establish patient perception to the impediments to safe and confident driving.
Results: The median time to return to baseline in THR was 2.0 weeks (95%CI 1.3-2.7) and in TKR 5.5 weeks (Log rank score 0.034). 14.3% of THR and 62.5% of TKR patients failed to reach baseline in the test period. The median time to return to baseline for all operation groups was 3.3 weeks in males (2.6 – 4.0) and 2.0 weeks in females (1.4 – 2.6) (Log rank 0.67). 18.2% of males and 45.5% of females failed to return to baseline in the test period. Males recorded faster transfer times at baseline than females (414ms and 573 respectively). Joint pain decreased markedly over the test period when scored by visual analogue score. TKR felt more joint pain at 1 week postoperative than THR (VAS 5.26 and 2.0 respectively). Perceived driving confidence had improved to baseline by 2 weeks postoperative. When asked, patients reported joint stiffness as the most troublesome symptoms in the postoperative period.
Discussion: THR recovered to their baseline transfer time significantly quicker than TKR. This may be due to TKR experiencing more pain in the immediate post-operative period. Females recovered to baseline quicker than males, however this observation was not statistically significant. There was significant loss to follow up in this study, which particularly affected the TKR group. There were a significant number of TKR patients who did not reach baseline in the study period. Without data past 6 weeks follow up it is difficult to make recommendations for the TKR group. We suggest that THR are safe to return driving 3-4 weeks after their operation date. Due to the time limitations of the BMedSci (Hons) programme the study size was smaller than desired. Following completion of this thesis data collection will continue to strengthen the findings of this study.