The aim of this study was to compare the effects of sequestrectomy versus conventional microdiscectomy on breaking response time (BRT) for lumbar disc herniation (LDH). BRT is the key factor for return to drive recommendations after surgery. A prospective clinical study was conducted. Patients aged 25-65 years who underwent surgery for lumbar disc herniation and held a valid motorcar driving license were recruited in a single institution. The patients were assessed before surgery, immediately after the surgery and at the follow up examination 30 days post-surgery. BRT was measured using a driving simulator, a visual analogue scale (VAS) was used for pain assessment. BRT values were compared with BRT values of a healthy control group. In patients treated with microdiscectomy BRT reduced from 749 (+/- 223) msec before surgery to 649 (+/- 223) msec immediately after the surgery. In the sequestrectomy group BRT reduced from 852 (+/- 561) msec before surgery to 693 (+/- 173) msec immediately after the surgery. BRT at follow up was 610 (+/- 145) cosec for patients treated with microdiscectomy and 630 (+/- 98) msec for patients operated with sequestrectomy. BRT for healthy controls was 487 (+/- 116) msec. Pain improved significantly for both patient samples. Sequestrectomy and microdiscectomy were associated with similar effects on pain and BRT after surgery. There was no statistically significant difference between BRT of both patient samples at 30 days follow up examination. Both surgical techniques showed a positive effect on BRT. No statistically significant difference between sequestrectomy and microdiscectomy on BRT could be found. (C) 2019 Elsevier Ltd. All rights reserved.

OBJECTIVE:The positive effect of primary lumbar disc surgery on braking reaction time (BRT) has already been shown. The authors investigated the effect of recurrent lumbar disc herniation surgery on BRT. METHODS:Twenty-four patients (mean age 49.9 years) were investigated for BRT 1 day before surgery, postoperatively before hospital discharge, and 4 to 5 weeks after surgery. Thirty-one healthy subjects served as a control group. RESULTS:Significant improvement of BRT following surgery was found in all patients (p < 0.05). For patients with right-sided recurrent disc herniation, median BRT was 736 msec before surgery, 685 msec immediately postoperatively, and 662 msec at follow-up. For patients with left-sided recurrent disc herniation, median BRT was 674 msec preoperatively, 585 msec postoperatively, and 578 msec at follow-up. Control subjects had a median BRT of 487, which differed significantly from the patient BRTs at all 3 test times (p < 0.05). CONCLUSIONS:A significant reduction in BRT in patients with recurrent disc herniation was found following lumbar disc revision surgery, indicating a positive impact of surgery. Due to the improvement in BRT observed immediately after surgery, we conclude that it is appropriate to recommend that patients keep driving after being discharged from the hospital.

Driving ability largely depends on the total brake response time (TBRT) corresponding to the time a subject needs to react to a stimulus and apply a well-defined force on the brake pedal. As yet, the English literature completely lacks clinical studies evaluating the TBRT following oral surgery. In this case-control study, a driving simulator was used to evaluate the TBRT in patients scheduled for oral surgery in local anesthesia. Measurements were taken shortly before (t1) and after (t2) surgery as well as 7–10 days later (t3) when sutures were removed. Results were compared to data of a group of healthy volunteers. Seventy-three patients (37 women, 36 men) underwent evaluation at t1, t2, and t3. In 13 patients who did not return for removal of sutures, only measurements at t1 and t2 could be performed. The median TBRT was 583 milliseconds (ms), 634 ms, and 520 ms at t1, t2, and t3, respectively. Statistical analysis revealed significant differences between readings at t1 versus t2 (t = − 4.944, p < 0.001), t1 versus t3 (t = 7.454, p < 0.001), and t2 versus t3 (t = 11.971, p < 0.001). There was no significant difference between TBRT at t3 in study subjects compared to normal reference values of 67 healthy volunteers. TBRT was significantly increased immediately after oral surgery (t2) compared to measurements 7–10 days postoperatively (t3). Since readings at t3 did not differ from TBRT values in the comparison group, they were considered normal. Due to significantly elevated total brake response time, driving ability is assumed to be considerably affected following oral surgery, and patients should be advised to abstain from driving immediately after such operations. Our study results put into question patients’ driving ability following dentoalveolar procedures which should be considered regarding informed consent and could potentially have consequences on health issues (road traffic accidents) as well as legal and financial matters (court charges, insurance claims).

To assess brake reaction time (BRT; key factor in driving ability) in patients receiving transfemoral coronary angiography (CAG). We assumed that patients would have a significantly impaired BRT after the procedure.

Background: The question whether or not a patient with a hip brace should drive a car is of obvious importance because the advice given to patients to resume driving is often anecdotal as few scientific data are available on this specific subject.Objectives: To assess driving ability (brake response time) with commonly used hip braces.Study design: Repeated measures design.Methods: Brake response time was assessed under six conditions: (1) without a brace (control), (2) with a typical postoperative hip brace with adjustable range of motion and the settings: unrestricted, (3) flexion limited to 70 degrees, (4) extension blocked at 20 degrees hip flexion, (5) both flexion and extension limited (20 degrees/70 degrees) and (6) an elastic hip bandage. Brake response time was assessed using a custom-made driving simulator as used in previous studies. The participants were a convenience sample of able-bodied participants.Results: A total of 70 participants (35 women and 35 men) participated in our study. Mean age was 31.1 (standard deviation: 10.6; range: 21.7-66.4)years. A significant within-subject effect for brake response time was found (p=0.009), but subsequent post hoc analyses revealed no significant differences between control and the other settings.Conclusion: Based on our findings, it does not seem mandatory to recommend driving abstinence for patients wearing a hip orthosis. We suggest that our results be interpreted with caution, because (1) an underlying pathological hip condition needs to be considered, (2) the ability to drive a car safely is multifactorial and brake response time is only one component thereof and (3) brake response time measurements were performed only with healthy participants.Clinical relevance Hip braces are used in the context of joint-preserving and prosthetic surgery of the hip. Therefore, clinicians are confronted with the question whether to allow driving a car with the respective hip brace or not. Our data suggest that hip braces do not impair brake response time.

Purpose Studies on driving safety after lumbar spinal procedures are rare. Previous studies solely reported on a) driving reaction time (DRT) after lumbar nerve root blocks, b) DRT after discectomy and c) preliminary DRT findings after lumbar fusion.Methods DRT was assessed with a driving simulator as described before. Measurements were done one day before surgery (preop DRT), one week after surgery (postop1 DRT), three months (postop2 DRT) and one year postoperatively (postop3 DRT). Back pain was determined with visual analogue scales (VAS) on all four occasions. Additionally, we monitored each patient's pre-operative driving frequency and intake of analgesics. For statistical analysis we used an ANOVA for repeated measurements.Results Thirt eight of 51 patients completed all measurements (17 monosegmental fusion, 14 polysegmental fusion, seven other lumbar fusion procedures). The longitudinal changes in DRT showed overall significance (p = 0.013). Post-hoc tests determined p = 0.035 for the DRT-increase from pre- to postoperative. We did not determine a significant statistical effect for the type of surgery (p = 0.581) or patient age (p = 0.134). A tendency towards statistical significance was ascertained for the influence of patients' driving frequency on DRT (p = 0.051).Conclusions We found increased DRT at the time of discharge after lumbar spinal fusion and therefore recommend driving abstinence for the time thereafter. Based on our findings it appears safe to return to driving at 3 months postoperative.

BACKGROUND:The aim of this study is to assess patients' driving ability when wearing surgical shoes following right-sided first metatarsal osteotomy.METHODS:From August 2013 to August 2015, 42 consecutive patients (mean age 54.5 years) with right-sided hallux valgus deformity underwent first metatarsal osteotomy. Patients were tested for brake response time (BRT) 1 day preoperatively (control run) and at 2 and 6 weeks postoperatively. Two different types of foot orthosis were investigated. BRT was assessed using a custom-made driving simulator.RESULTS:Preoperative BRT was 712 msec (standard deviation (SD), 221 msec). BRT was significantly slower at all tested postoperative times than preoperatively (p < 0.001). The patients showed significant impaired brake response time when wearing surgical shoes. Mean global American Orthopaedic Foot and Ankle Society (AOFAS) outcome score and AOFAS pain and alignment subscores increased postoperatively (p < 0.001).CONCLUSIONS:From our findings, we recommend driving abstinence for a minimum of 6 weeks postoperatively when using a surgical shoe after bunionectomy. However, patients should have sufficient recovery, exercise, and training before resuming driving a car, because safety is always a priority.TRIAL REGISTRATION:ClinicalTrials.gov, NCT02354066.

INTRODUCTION:The question whether or not a patient with an ankle brace should drive a car is of obvious importance because brake response time (BRT) is considered one of the most important factors for driving safety.MATERIALS AND METHODS:Applying a crossover study design, 70 healthy participants (35 women, 35 men) participated in our study. BRT was assessed using a custom-made driving simulator. We assessed BRT under six conditions: without a brace (control) (1), with a typical postoperative ankle brace with adjustable ROM and the settings: unrestricted (2), fixed at 15° (3) plantar flexion, restricted with 15°/50° (4) (dorsal/plantar flexion), a brace for ligament instabilities (5) and an elastic ankle bandage (6). Participants were instructed to apply the brake pedal exclusively with the right foot as quickly as possible on receipt of a visual stimulus.RESULTS:The 70 participants showed significantly impaired BRT with the ankle brace for ROM restriction in the settings: unrestricted (p<0.001), fixed at 15° plantar flexion (p<0.001) and 15°/50° dorsal/plantar flexion (p<0.001) as compared to the control group. BRT was not impaired with the brace for ankle instabilities or the elastic ankle bandage.CONCLUSIONS:In conclusion, right-sided ROM restricting ankle braces involve significant impairment of BRT in healthy participants. No such prolonged BRT was found for an elastic ankle bandage or the ligament brace.

Introduction Due to the current lack of evidence the aim of this study was to investigate the driving ability after right-sided ankle arthroscopy. Materials and Methods Nineteen patients underwent right-sided ankle arthroscopy. Brake response time (BRT) was assessed preoperatively, 2 days, 2 weeks, 6 weeks, and 12 weeks postoperative. We also determined patients' clinical outcome (AOFAS and AOS questionnaires) and their driving frequency. Results BRT was 606 ms preoperatively and changed to 821 ms 2 days postoperative (p < 0.001). The further postoperative BRT course was 606 ms (2 weeks), 596 ms (6 weeks) and 603 ms (12 weeks) (p = n.s.). In addition, a significant influence of the AOS and AOFAS scores on BRT was found, namely poorer clinical outcome also leads to a prolonged BRT (p < 0.01 for both). BRT was significantly prolonged in patients with little driving frequency (p = 0.001). Furthermore, the 'time-by-driving interaction' was significant (p = 0.018), which means the BRT-peak on the second day was much lower in low-frequency drivers. Conclusions From the findings made in the current study we conclude that a driving abstinence of two weeks is necessary following right-sided ankle arthroscopy. Greater driving frequency and good clinical outcome seem to be associated with better driving ability. However, for the time being no exceptions should be made from the above-mentioned recommendation on driving abstinence.

Background: Overuse injuries of the back are a common complaint among top athletes and of competitive alpine skiers in particular. However, there is limited understanding about the sport-specific causes of these injuries that is essential for their prevention. Purpose/Hypothesis: This study was undertaken to describe the sport-specific, overall trunk kinematics and skiers’ loading during giant slalom turns and to assess the plausibility of the hypothesis that a combination of frontal bending, lateral bending, and/or torsion in the loaded trunk might be a potential mechanism leading to overuse injuries of the back in alpine ski racing. Study Design: Descriptive laboratory study. Methods: Eight European Cup–level athletes performed giant slalom runs with 2 different pairs of skis (varying in length, width, and sidecut). They were analyzed with respect to selected kinematic variables related to spinal disc loading. The overall trunk movement components (frontal bending, lateral bending, and torsion) were measured using 2 inertial measurement units fixed on the sacrum and sternum. Total ground-reaction forces were measured by pressure insoles. Results: During the turn phase in which the total ground-reaction forces were the greatest (up to 2.89 times the body weight), the highest average values of frontal bending (38.7°), lateral bending (14.7°), and torsion (7.7°) in the trunk occurred. Similar magnitudes were observed when skiing on longer, giant slalom skis with less width and sidecut. Conclusion: The typical loading patterns of the back in alpine ski racing include a combined occurrence of frontal bending, lateral bending, and torsion in the loaded trunk. Because these factors are known to be related to high spinal disc loading, they may be considered important components of mechanisms leading to overuse injuries of the back in alpine ski racing. Clinical Relevance: Prevention measures should aim to control and/or reduce the magnitude of frontal bending, lateral bending, and torsion in the trunk, as well as the peak loads, while skiing.

Purpose: To assess driving ability (brake response time [BRT]) with commonly used knee braces. Methods: Sixty-four healthy participants (32 women and 32 men) participated in our study. BRT was assessed using a custom-made driving simulator. We assessed BRT for 5 different commonly used knee braces (right leg) used in 9 different settings: without a knee brace (control group); with a typical postoperative knee brace with adjustable range of motion (ROM) and the settings of 0 degrees to 30 degrees, 0 degrees to 60 degrees, 0 degrees to 90 degrees, and 20 degrees to 90 degrees (extension and flexion); and with an unloading knee brace for moderate to severe unicompartmental osteoarthritis, an orthosis for ligament instabilities, a knee brace for patellofemoral disorders, and an elastic knee bandage. Results: The 64 participants (mean age, 33.5 years) showed significantly impaired BRT with the typical postoperative brace set at an ROM of 0 degrees to 30 degrees (673 milliseconds, P <.001), ROM of 0 degrees to 60 degrees (629 milliseconds, P <.001), ROM of 0 degrees to 90 degrees (607 milliseconds, P = .001), and ROM of 20 degrees to 90 degrees (602 milliseconds, P = .005) compared with the control group. However, no such impaired BRT was found for any other investigated knee brace. Conclusions: Right-sided ROM-restricting knee braces involve significant impairment of BRT in healthy participants. No such prolonged BRT was found for a patellofemoral realignment brace, a ligament brace, a valgus/osteoarthritis brace, or an elastic knee bandage. However, our findings should be viewed in light of the limitations of the study, which are (1) the lack of a defined decrease in BRT that could lead to an accident and (2) uncertainty of whether the statistical differences are also clinically important.

The objective of the study was to clarify whether driving abstinence should be recommended when patients are discharged from hospital after unicompartmental knee arthroplasty (UKA). We tested the hypotheses that there are differences in the peri-operative course of brake response time in patients undergoing right-sided (1) or left-sided (2) UKA. Additionally, we tested whether brake response time is significantly influenced by pain (3), driving experience (4) or age (5).

Reduced driving reaction time (DRT) has already been studied in context with lumbar disc surgeries. Data on whether cervical spine pathologies impair driving abilities are still lacking. In addition, no return-to-driving recommendations after anterior cervical fusion procedures have been published. Therefore, we assessed DRT before and after anterior cervical discectomy and fusion.We performed a prospective study with 12 patients (mean age 47.2 years; female 7, male 5). DRT as well as arm and neck pain were evaluated before surgery, on the day before discharge from hospital and at the 4-6-week follow-up examinations. 31 healthy subjects were tested for DRT as a control group.All patients showed significant improvement in DRT in the longitudinal course (p < 0.05). DRT was 601 ms (median, IQR: 63) before surgery, which was reduced to 580 ms (median, IQR: 112) on the day before discharge from hospital and to 532 ms (median, IQR: 48) at follow-up examination. Control subjects had a driving reaction time of 487 ms (median, IQR: 116), which differed significantly from that of patients at all three testing times (p < 0.05). VAS for arm and neck pain showed significant improvement (p < 0.05).The present results show a positive effect of anterior cervical discectomy and fusion on driving safety. Based on our data we state that it appears to be safe to resume driving after discharge from hospital. However, patients scheduled to undergo anterior cervical discectomy and fusion should be informed about increased DRT as compared to healthy individuals.

Hohe Bandscheibenbelastungen entstehen während des Golfschwunges aufgrund von kombinierter axialer Rotation und Beugebewegung der Wirbelsäule. Hohes Bewegungsausmaß erhöht die Belastungen. Muskuläre Stabilisation des Rumpfes verringert Bandscheibenprobleme. Die Verringerung der Beuge- und Rotationsbewegung und die muskuläre Stabilisierung sind daher geeignete Maßnahmen, um Wirbelsäulenbelastungen während des Golfschwunges zu reduzieren.

In minimally invasive hip arthroplasty double offset broach handles are used, to facilitate the preparation of the femoral canal. The aim of this study was to quantify the differences in force and impulse transmission between two double offset broach handles and a single offset broach handle. Two double offset broach handles (A European version, B American version) were compared to a single offset broach handle. A surgical hammer was used to give a variable impact to the head of the broach handle. Thirty measurements for each of five falling heights were recorded for each broach handle. The force measured by a load cell connected to the broaches was used to obtain the maximum force peak and to calculate the impaction impulse. Normal data distribution was assumed and analysis of variances was performed. Results have demonstrated that the highest values of the force peak and force impulse were found in the single offset broach handle. Broach handle A had higher impulse values and lower maximum force values compared to broach handle B. The lateral lever arm has a measurable effect on the force transmission. In double offset broach handles less energy is transmitted to the tip. Surgeons have to be aware of the differences between the broach handles when using them intraoperatively.

In Total Hip Arthroplasty (THA) bone loss is recovered by using compacted porous bone chips. The technique requires the morsellised allograft to be adequately compacted to provide initial stability for the prosthesis in order to prevent early massive subsidence and to induce bone remodeling. Therefore the bone grafts provide initial stability and an environment in which revascularization and incorporation of the graft into the host skeleton may occur. Acetabular reconstruction with impacted morsellised cancellous grafts and cement leads to satisfactory long-term results. In the acetabular impact-grafting procedure, a hammer and an impaction stick is used for manual compaction. Another technique uses a hammer driven by compressed air, which could lead to higher density and improved stability of bone chips in the acetabulum. The aim of this study was to compare two different compaction modes for bone impaction grafting for the acetabulum. The hypothesis was that a pneumatic impaction method would produce less variable results than the manual impaction mode and lead to better compaction results of the bone chips in less time. Bone mass characteristics were measured by force and distance variation of a penetrating punch, which was lowered into a plastic cup filled with bone chips. For each compaction method and for each time interval (0, 3, 6, 9, 12, 15 and 30 [s] of compaction time) 30 measurements of force and distance variations were taken. From the measurements of force and distance variations bulk density, contact stiffness, impaction hardness and penetration resistance were calculated before and after the established time intervals of compaction. Since not all data was normally distributed the non-parametric U-Test was used for comparison of the two impaction methods. Particle size distribution was determined using sieve analysis according to Din 18123 standard after the compaction experiments. Results have shown that the pneumatic method leads to higher values in impaction hardness, contact stiffness and bulk density and is more suitable to increase the primary stability of the implant. The differences in bulk density, impaction hardness and contact stiffness where statistically significant (p u , calculated from the particle size distribution determined by the sieve analysis, has a value of 3.8. The particle size distribution is comparable to the results published in literature. Pneumatic impaction achieves higher density values in less time with less force applied and results in more reproducible outcomes when used. It reduces therefore the risk of bone fracture, as smaller peak forces are used for less time. However for optimal osteointegration it is not recommended to achieve maximum density. Further clinical studies should determine a reference value for optimal growth-in of osteocytes. Manual impaction shows more variable results and depends much on the experience of the surgeon. The pneumatic hammer is therefore a suitable tool to standardize the impaction process for acetabular bone defects.

Although patients scheduled to undergo lumbar disc surgery often ask when they are allowed to drive a motor vehicle again, there are no published recommendations on this subject.We conducted a prospective study in 46 consecutive patients (mean age 48.9 years) to determine driving reaction time (DRT) before and after surgery in patients with lumbar disc herniation. Of the patients 23 had left-side radiculopathy and 23 right-side radiculopathy. Driving reaction time as well as back and leg pain were evaluated preoperatively, on the day of discharge from hospital and at the 5-week follow-up examination (FU). 31 healthy subjects were tested as controls.Significant improvement in DRT was seen for both patient samples (p < 0.05). For patients with a right-side radiculopathy preoperative DRT was 664 ms (median, IQR: 241), which was reduced to 605 ms (median, IQR: 189) immediately postoperatively and to 593 ms (median, IQR: 115) at FU. For patients with a left-side radiculopathy DRT was 675 ms (median, IQR: 247) preoperatively, 638 ms (median, IQR: 242) postoperatively and 619 ms (median, IQR: 162) at FU. Pain was moderately correlated to DRT. Control subjects had a driving reaction time of 487 (median, IQR: 116), which differed significantly from patients at all three testing times (p < 0.001).Our data indicate a positive effect of the surgery on driving ability. Therefore, we would suggest that for both patient samples it is safe to continue driving after hospital discharge. However, patients have to be informed about increased DRT caused by radiculopathy already before surgery.

In minimally invasive direct anterior total hip arthroplasty double offset broach handles are used, in order to facilitate the preparation of the femoral canal. The maximum value of the main force peak and the impulse of two types of double offset broach handles (A European version, B American version) were compared to a single offset broach handle (S). Results have demonstrated that the highest values of the main force peak and force impulse were found in the single offset broach handle. Broach handle A had higher impulse values and lower maximum force values compared to broach handle B. In double offset broach handles less energy is transmitted to the tip. Broach handle A has a lower force peak than B and therefore a reduced risk of bone fracture.

In revision total hip replacement, bone loss can be managed by impacting porous bone chips. In order to guarantee sufficient mechanical strength, the bone chips have to be compacted. The aim of this study was to determine in an in vitro simulation whether the use of a pneumatic hammer leads to higher primary stability than manual impaction. Bone mass characteristics were measured by force and distance variation of a penetrating punch, which was lowered into a plastic cup filled with bone chips. From these measurements bulk density, contact stiffness, impaction hardness and penetration resistance were calculated for different durations of impaction. We found that the pneumatic method reached higher values of impaction hardness, contact stiffness and bulk density suggesting an increase in stability of the implant. No significant differences were found between the two different methods concerning the penetration resistance. The pneumatic method might reduce the risk of fracture in vivo, as force peaks are smaller and applied for a shorter period. Results from manual impaction showed higher variability and depend much on the experience of the surgeon. The pneumatic hammer is a suitable tool to standardise the impaction process.

In revision total hip replacement, bone loss can be managed by impacting porous bone chips. In order to guarantee sufficient mechanical strength, the bone chips have to be compacted. The aim of this study was to determine in an in vitro simulation whether the use of a pneumatic hammer leads to higher primary stability than manual impaction. Bone mass characteristics were measured by force and distance variation of a penetrating punch, which was lowered into a plastic cup filled with bone chips. From these measurements bulk density, contact stiffness, impaction hardness and penetration resistance were calculated for different durations of impaction. We found that the pneumatic method reached higher values of impaction hardness, contact stiffness and bulk density suggesting an increase in stability of the implant. No significant differences were found between the two different methods concerning the penetration resistance. The pneumatic method might reduce the risk of fracture in vivo, as force peaks are smaller and applied for a shorter period. Results from manual impaction showed higher variability and depend much on the experience of the surgeon. The pneumatic hammer is a suitable tool to standardise the impaction process.