Return to Driving Following Foot Surgery, A Systematic Review

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Total Ankle Arthroplasty (TAA) utilization is increasing for the treatment for ankle arthritis due to improved designs and successful patient reported outcomes. Rehabilitation protocols are different among ankle arthroplasty juxtaposed to arthrodesis. Advice to patients on return to driving often varies among surgeons. The purpose of this study was to review and analyze the current available evidence on brake reaction time and safe return to driving in ankle arthroplasty compared to arthrodesis. Methods: A systematic review of the literature was performed in accordance with PRISMA guidelines. We independently conducted a literature search throughout August of 2024 using PubMed and Cochrane databases for articles using the terms: (((return to drive) AND (foot surgery)) AND (ankle surgery)) AND (driving) AND (Brake). A total of 49 articles were reviewed based on search criteria. All included articles used brake reaction time (BRT) as an reported outcome measure. Results: The included studies evaluated safety to return to driving in ankle arthrodesis and ankle arthroplasty. A total of four studies met final inclusion criteria and were in this review, 2 assessed ankle arthroplasty and 2 assessed ankle arthrodesis. Of these, 121 patients were reviewed with 40 controls, 22 ankle fusions and 59 ankle replacements. The mean weighted age was 57 years. 100% of the surgery was performed on the right ankle. Postoperative brake reaction time was faster for the control group (0.45 sec) when compared to ankle arthrodesis (0.57 sec) and ankle arthroplasty (0.62 sec). Conclusion: Both the ankle arthrodesis and ankle arthroplasty groups showed slower times compared to the control; however, their times were still within the acceptable range for safe highway driving after surgery. Contrary to expectations, the ankle arthrodesis group demonstrated slightly faster braking times than the ankle arthroplasty group, though the difference was minimal. Further prospective studies are needed to assess improvement in brake reaction time during the postoperative period.