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

Background: 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. Methods: 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. Results: 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). Conclusion: 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.