Reaction time and brake pedal force after total knee replacement: timeframe for return to car driving

PURPOSE

This prospective cohort study aimed to examine objective and subjective parameters in patients who underwent total knee replacement (TKR) to assess from when on driving a car can be deemed safe again.

METHODS

Thirty patients (16 women, 14 men, age 66 ± 11 years) who received TKR of the right knee and 45 healthy controls (26 women, 19 men, age 32 ± 9 years) were asked to perform an emergency braking manoeuvre using a driving simulator. Brake pedal force (BPF), neuronal reaction time (NRT), brake reaction time (BRT), and subjective parameters (pain, subjective driving ability) were measured preoperatively as well as 5 days, 3-4, and 6 weeks after TKR.

RESULTS

Preoperative NRT was 506 ± 162 ms, BRT 985 ± 356 ms, and BPF 614 ± 292 N. NRT increased to 561 ± 218 ms, BRT to 1091 ± 404 ms and BPF decreased to 411 ± 191 N 5 days after TKR. Three weeks after surgery, NRT was 581 ± 164 ms and BRT 1013 ± 260 ms, while BPF increased to 555 ± 200 N. Only BPF showed significant differences (p < 0.01). In week 6, all parameters were restored to baseline levels; patients showed significant pain decrease and evaluated their driving ability as "good" again.

CONCLUSION

BPF was the only parameter displaying a significant postoperative decrease. However, preoperative patients' baseline levels and subjective confidence in driving ability were only reached 6 weeks after the operation. These results indicate that a minimum waiting period of 6 weeks should be considered before patients can safely participate in road traffic at their individual preoperative safety level again.

LEVEL OF EVIDENCE

II.

Modelling braking behaviour and accident probability of drivers under increasing time pressure conditions

Drivers apply brakes to reduce the speed of a vehicle based on the perceived risk while approaching a certain event. Inadequate or excessive braking can lead to serious consequences. The current study analyses the braking behaviour and accident probability of the drivers under increasing time pressure conditions. Two perilous events (pedestrian crossing and obstacle overtaking) were designed to examine Brake Pedal Force (BPF) and Brake-To-Maximum Brake (BTMB) transition time on a driving simulator. Eighty-five Indian licensed drivers drove the simulator in three different time pressure conditions: No Time Pressure (NTP) (baseline), Low Time Pressure (LTP), and High Time Pressure (HTP). Random parameters Tobit model was used for analysing BPF and duration analysis approach was considered for BTMB analysis. Further, generalized linear mixed model with logit link function was used to study the effect of BPF and BTMB on accident probability of the drivers. The model results showed that gender, driving profession, approach speed, age, driving history, and driving condition significantly affected braking behaviour of the drivers. It was observed that in pedestrian crossing event, LTP and HTP driving conditions resulted in 42.31 % and 87.28 % increase in BPF and 13 % and 23 % reduction in BTMB respectively with respect to NTP driving condition and the corresponding changes were slightly lower in case of obstacle overtaking event. The accident probability model showed that female drivers needed 119.70 % and 186.08 % more BPF and 37.55 % and 58.51 % less BTMB in LTP and HTP driving conditions respectively to have equivalent risk levels as observed for male drivers. Further, non-professional drivers had to increase their BPF by 166.83 % in LTP and 219.93 % in HTP to offset their increased accident risk as compared to professional drivers under time pressure conditions.