Evaluation of the Impact of Tibiotalar Fusion and Total Ankle Arthroplasty on Simulated Driving

Category: Ankle Arthritis; Ankle Introduction/Purpose: Tibiotalar Fusion (TF) and total ankle arthroplasty (TAA) are both viable choices for addressing tibiotalar osteoarthritis. Nevertheless, a definitive agreement on the most effective approach to restore optimal function, particularly in terms of safe emergency braking during car driving, is yet to be established. The primary aim of this investigation was to evaluate the break reaction time (BRT), total braking time (TBT), and maximal braking force (MBF) in individuals who underwent TF and TAA using a validated driving simulator. Secondary outcomes encompassed patient-reported measures of pain and functional outcomes. Methods: This observational study assesses the emergency braking capabilities of individuals undergoing either total ankle arthroplasty (TAA) or tibiotalar fusion (TF) in simulated driving scenarios. The participants were categorized into three groups: 1) TAA, 2) TF, and 3) Healthy Elderly (HE) aged 75 years and older, deemed still fit for driving. To be eligible for evaluation on the driving simulator, patients in the TAA and TF groups were required to have a minimum of a 1-year follow-up. Break reaction time (BRT), total braking time (TBT), and maximal braking force (MBF) were recorded with and without distraction during a single visit to the research center. Additionally, Ankle Osteoarthritis Scale (AOS) results were collected for all participants in TF and TAA. Results: This study, conducted between 2018 and 2022, included a total of 84 participants, with 21 TF, 21 TAA, and the remaining 42 serving as healthy elderly controls (HE). There was no significant difference between the TF and TAA groups with respect to MBF (p=0.4921), BRT (p=0.8734) or TBT (p= 0.7989). The TAA group and the TF group were significantly faster than the HE regarding TBT with a distraction (p=0.0463 and p=0.0049 respectively). The AOS score was significantly better in the TAA group compared to the TF group (p=0.002). Conclusion: The emergency braking capacity in total ankle arthroplasty (TAA) patients is not inferior to that in tibiotalar fusion (TF) patients. Both groups also performed better than elderly drivers meeting a minimally acceptable braking safety threshold. Thus, both treatment options appear to have a similar impact on braking capacity.