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Brake Response Time Is Significantly Impaired After Total Knee Arthroplasty

Investigation of Performing an Emergency Stop While Driving a Car

Jordan, Maurice MD; Hofmann, Ulf-Krister MD; Rondak, Ina; Götze, Marco MD; Kluba, Torsten MD; Ipach, Ingmar MD

American Journal of Physical Medicine & Rehabilitation: September 2015 - Volume 94 - Issue 9 - p 665–676
doi: 10.1097/PHM.0000000000000342
Original Research Articles: CME Article . 2015 Series . Number 9

Objective The objective of this study was to investigate whether total knee arthroplasty (TKA) impairs the ability to perform an emergency stop.

Design An automatic transmission brake simulator was developed to evaluate total brake response time. A prospective repeated-measures design was used. Forty patients (20 left/20 right) were measured 8 days and 6, 12, and 52 wks after surgery.

Results Eight days postoperative total brake response time increased significantly by 30% in right TKA and insignificantly by 2% in left TKA. Brake force significantly decreased by 35% in right TKA and by 25% in left TKA during this period. Baseline values were reached at week 12 in right TKA; the impairment of outcome measures, however, was no longer significant at week 6 compared with preoperative values. Total brake response time and brake force in left TKA fell below baseline values at weeks 6 and 12. Brake force in left TKA was the only outcome measure significantly impaired 8 days postoperatively.

Conclusion This study highlights that categorical statements cannot be provided. This study’s findings on automatic transmission driving suggest that right TKA patients may resume driving 6 wks postoperatively. Fitness to drive in left TKA is not fully recovered 8 days postoperatively. If testing is not available, patients should refrain from driving until they return from rehabilitation.

To Claim CME Credits: Complete the self-assessment activity and evaluation online at

CME Objectives: After completion of this article, readers should be able to: (1) List important parameters of driving ability; (2) Describe the effect of TKA on driving parameters; (3) Formulate an individualized treatment plan; and (4) To return patients to safe driving after TKA.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Department of Orthopaedic Surgery, University Hospital of Tübingen, Tübingen, Germany (MJ, U-KH, MG, TK); Institute for Medical Statistics and Epidemiology, University Hospital of the Technical University of Munich, Munich, Germany (IR); and Department of Orthopedic Surgery, Hospital of Ingolstadt, Ingolstadt, Germany (II).

All correspondence and requests for reprints should be addressed to: Maurice Jordan, MD, Department of Orthopaedic Surgery, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen D-72076, Germany.

The authors did not receive any grants or funds. There was no financial benefit for the authors. The results of this study have not been previously presented or published.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.