A Review of the Effect of Lower-Extremity Pathology on Automobile Driving Function

Return to Driving After Hip Arthroscopy: A Systematic Review and Meta-analysis

Background:

Hip arthroscopy is an increasingly common procedure; however, recommendations for safely returning to driving after hip arthroscopy vary among surgeons.

Purpose:

To systematically review and analyze the current available evidence on the optimal time to safely return to driving after hip arthroscopy.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

A systematic review and meta-analysis was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two authors independently conducted a literature search throughout August 2021 using the PubMed, Google Scholar, Embase, and Cochrane databases. A total of 1425 articles were reviewed, and 5 articles were included. All included articles used brake reaction time (BRT) as an observer-reported outcome measure. A meta-analysis was performed to compare pre- and postoperative BRT values. Study sample sizes and mean BRT values were collected per each included study. First, data were analyzed for the right and left hips combined; then, a subgroup analysis stratified by laterality was performed. The BRT values were divided according to time periods of measurement: preoperatively and 2, 4, 6, and 8 weeks postoperatively.

Results:

The included studies evaluated safety to return to driving after hip arthroscopy in 160 patients. Of these, 142 patients were treated for femoroacetabular impingement, while 18 patients underwent hip arthroscopy for other diagnoses. The mean weighted age was 33.7 ± 9.0 years, 47.5% of the patients were female, and the right hip was affected in 71.2%. The preoperative range of BRT was 566 to 1960 ms, and postoperative BRT range was 567 to 1840 ms at 1 to 2 weeks and 523 to 1860 ms at 3 to 12 weeks. Meta-analysis found the studies to be moderately heterogenic ( P = .06). There were no statistically significant differences in BRT between the preoperative period and at 2, 4, 6, and 8 weeks postoperatively.

Conclusion:

Return to driving is likely safe as early as 2 to 4 weeks after right-sided hip arthroscopy, and 2 weeks after a left-sided procedure, as driving performance returns to the preoperative level.

Registration:

CRD42021274460 (PROSPERO identifier).

Return-to-Driving Recommendations After Lower-Extremity Orthopaedic Procedures

Following lower-extremity orthopaedic surgery, recommendations for safe return to driving include at least 6 to 12 weeks for a right ankle fracture, 2 days to 2 weeks for a right ankle arthroscopy, 6 to 9 weeks for a total ankle arthroplasty, 6 to 7 weeks for a right Achilles tendon rupture repair, 1 to 4 weeks for a right total knee arthroplasty, 2 weeks for a left total knee arthroplasty, 3 to 6 weeks for a right anterior cruciate ligament repair, and 1 to 4 weeks for a total hip arthroplasty. Important individual factors such as extent of injury, laterality of injury, current driving habits, type of vehicle transmission (manual or automatic), and medical comorbidities must be taken into consideration. State laws vary widely and often use vague language to describe the legal responsibilities that orthopaedic surgeons have when providing return-to-driving recommendations.