Return to AAOS 2014 Annual Meeting
436-450-Shoulder and Elbow III
Thursday, Mar 13, 2014, 10:42 AM -10:48 AM
Driving Performance after Total Shoulder Arthroplasty
+Shoulder- arthroplasty (primary, revision, reverse) (Shoulder/Elbow)
Arthroplasty / Primary / Revison and Arthrodesis; Shoulder Instability / Clinical Applications; Outcomes
, BS, Commack, New York
, BA, BS, New York, New York
Joseph D. Zuckerman
, MD, New York, New York
INTRODUCTION: Recent evidence demonstrates that an increasing number of shoulder arthroplasties are performed each year. However, proper guidelines on patient safety and return to driving postoperatively have yet to be defined. This study seeks to quantify perioperative changes in driving performance following anatomic and reverse shoulder arthroplasty using a driving simulator.
METHODS: A previously validated driving simulator was used to develop a virtual circuit in which hazardous conditions necessitated evasive maneuvers. Twenty-eight patients (18 anatomic and 10 reverse shoulder arthroplasties) with a mean age 65 ± 10 years were tested at four distinct time points perioperatively. Trial 1 was conducted prior to surgery; trial 2 was held approximately 14 days after surgery; trials 3 and 4 occurred at six and 12 weeks after surgery, respectively. The number of total collisions, off-road collisions, on-road collisions, center-line crosses and off-road excursions were recorded at each trial. Each circuit was customized to the driver’s reaction time to limit variability between course output measures. Pain Visual Analog Scale (VAS), Shoulder Pain and Disability Index (SPADI) scores were documented, in addition to annual driving mileage and hours slept the previous night.
RESULTS: Preliminary: In 28 subjects, the mean number of collisions decreased from 6.2 at Trial 1 (pre-op) to 5.9 at Trial 2 (2-wk post-op), (p = 0.05). The mean number of collisions subsequently decreased to 5.2 by Trial 3 (6-wk post-op), and 4.2 by Trial 4 (12-wk post-op). There was a statistically significant difference in the mean number of collisions between Trial 1 and Trial 4, (p < 0.05). Comparing those that drove less than 1,800 miles per year to those who drove at least 8,700 miles per year, low mileage drivers incurred a statistically significant increase in the number of collisions at Trial 1 (pre-op), (p < 0.05) and Trial 4 (12-wk post-op), (p < 0.05). In addition, “at-risk driving behavior” quantified as the number of centerline crosses decreased from 20.6 at Trial 1 (pre-op) to 14.8 by Trial 4 (12-wk post-op), (p < 0.005). The mean VAS scores for pain and SPADI scores decreased across all trials (p < 0.005). No significant difference was observed in the number of collisions relative to hours slept.
CONCLUSIONS: At 12 weeks status post anatomic or reverse total shoulder arthroplasty, patients showed improved driving performance, with a significant decrease in the number of collisions in the simulated driving course compared to preoperative and two weeks post-operative trials. It is our recommendation, based on improvements in VAS scores for pain and SPADI scores, and secondary outcome measures of “at-risk driving behavior” over time, that patients refrain from driving for at least six weeks. The present study findings suggest that patients undergoing total shoulder replacement show improvement in driving performance with the mitigation of shoulder pain and discomfort.
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