The Relationship Between Driving Performance and Lower Limb Motor Function After Total Knee Arthroplasty Using a Driving Simulator: A Pilot Study on Elucidating Factors Influencing Accelerator and Brake Operations

TL;DR

This study explores how lower limb function affects driving performance after knee replacement surgery, using a driving simulator to measure accelerator and brake operations.

Contribution

The study identifies walking ratio and pain levels as key factors influencing driving performance after total knee arthroplasty.

Findings

Movement time was significantly correlated with knee extension strength and walking ratio.

Brake pedal force was significantly associated with walking ratio and pain levels.

Walking ratio was a significant predictor for both movement time and brake pedal force.

Abstract

Background: The aging population in Japan has led to an increase in traffic accidents involving elderly drivers, highlighting the need for measures to enhance driving safety. Post-total knee arthroplasty (TKA) patients must regain their driving ability to maintain independence; however, clear guidelines for driving resumption are lacking. This study assessed the movement time (MT) and brake pedal force (BPF) using a driving simulator and investigated their associations with lower limb motor function. Methods: This single-center prospective cohort study included 21 patients (mean age: 66.7 ± 7.4 years) who underwent right TKA and intended to resume driving. Driving ability was assessed on postoperative day 13 using a driving simulator to measure MT and BPF. Physical function was evaluated using the following parameters: range of motion (ROM), muscle strength, gait parameters, and pain assessment. Pearson’s correlation and multiple regression analyses were performed to identify significant associations. Results: MT was significantly correlated with knee extension strength (r = −0.56, p = 0.02) and walking ratio (r = 0.55, p = 0.03). BPF was significantly correlated with walking ratio (r = 0.52, p = 0.04) and pain levels VAS (r = −0.54, p = 0.02). Multiple regression analysis identified walking ratio (β = 0.54, p = 0.02) as a significant predictor of MT. For BPF, significant predictors included walking ratio (β = 0.49, p = 0.03) and VAS (β = −0.54, p = 0.02). Discussion: The findings of this study suggest that MT is associated with walking ratio, while BPF is significantly associated with both walking ratio and VAS scores. In particular, walking ratio was found to have a significant impact on both MT and BPF, indicating that it may be an important factor influencing postoperative driving performance. Conclusion: Improvement in the walking ratio and pain management affect accelerator and brake operation during driving after TKA.

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