title: Driving and emergency braking may be impaired after tibiotalar joint arthrodesis: conclusions after a case series.
abstract: OBJECTIVE
  To assess whether reaction time (RT) and movement time (MT), as the two components of the total brake response time (TBRT) and brake force (BF) are different in patients with a foot joint arthrodesis in comparison to controls.
  
  
  METHODS
  The study was a comparative case series in a driving simulator under realistic driving conditions. Mobile patients without a walker, ≥6 months after surgery who were driving a car and had no neurological co-morbidity, knee or hip joint prosthesis were included in the study. The selection criteria resulted in 12 patients with right tibiotalar joint arthrodesis (TTJA) and 12 patients with another right foot joint arthrodesis (OFJA), who were compared to 17 individuals without any ankle-joint pathology. For TBRT, an empirical safe driving threshold of 700 ms was used. The outcome measures were RT, MT, TBRT, BF and McGuire score.
  
  
  RESULTS
  MT (p = 0.034) and TBRT (p = 0.026) were longer in TTJA patients in comparison with the controls. Also, more patients with TTJA than patients with OFJA and controls exceeded the safe driving threshold (p = 0.028). The outcomes in OFJA patients and in controls were comparable. The McGuire score was similar between the TTJA and OFJA patients (p = 0.26).
  
  
  CONCLUSIONS
  Significantly slower MT and TBRT, and significantly more patients exceeding the safe driving threshold, were observed after a tibiotalar-joint arthrodesis in comparison to the controls. Patients with OFJAs were not significantly different from the controls. Driving and emergency braking may be impaired after tibiotalar-joint arthrodesis.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland, sschwienbacher84@googlemail.com.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwienbacher
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.forename: Ulf Krister
authors.initials: UK
authors.lastname: Hofmann
authors.forename: Maurice
authors.initials: M
authors.lastname: Jordan
authors.forename: Antongiulio
authors.initials: A
authors.lastname: Marmotti
authors.forename: Christoph
authors.initials: C
authors.lastname: Röder
authors.forename: Ingmar
authors.initials: I
authors.lastname: Ipach
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D019643:Arthroplasty, Replacement; D001334:Automobile Driving; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D011930:Reaction Time; D013628:Talus / Q000601:surgery*; D013977:Tibia / Q000601:surgery*; D055815:Young Adult