No abstract

Background/Objective: Advice given to patients on driving resumption after total hip arthroplasty (THA) is inconsistent. Due to a lack of clear guidelines, surgeons’ recommendations range between 4–8 weeks after surgery to resume driving. Delays in driving return can have detrimental social and economic impact. However, it is important to ensure patients only resume driving once safe. This study presents a systematic review and meta-analysis of driving simulation studies after THA to establish when patients can safely return to driving postoperatively. Methods: A systematic review and meta-analysis using PRISMA guidelines was undertaken. Titles and abstracts were screened for inclusion, data was extracted, and studies assessed for bias risk. Review Manager, was used for statistical analysis. Values for brake reaction time (BRT) were included for meta-analysis. Results: 14 articles met the inclusion criteria. Of these, 7 measured BRT and were included in the meta-analysis. Pooled means of both right and left THA showed BRT around or above preoperative baseline at 1 week, 2 weeks and 3 weeks, and below baseline at 6 weeks, 12 weeks, 32 weeks and 52 weeks. Of these, the pooled means at 6, 32, and 52 weeks were significant ( p < 0.05). Studies not meeting meta-analysis inclusion criteria were included in a qualitative analysis, examining self-reported postoperative driving return times which ranged from 6 days to over a year or in rare cases, never. Majority of patients ( n = 960) self-reported driving return within approximately 6 weeks (pooling of mean values 32.9 days). Conclusions: The mean return to driving time recommended in the literature was 4.5 weeks. Based upon BRT meta-analysis, a return to baseline braking performance was noted at 6 weeks postoperatively. However, driving is a complex skill, and patient recommendation should be individualised based on factors such as vehicle transmission type, THA technique, surgical side, medication and comorbidities.

IGF1R-related disorders are associated with intrauterine growth restriction (IUGR), postnatal growth failure, short stature, microcephaly, developmental delay, and dysmorphic facial features. We report a patient who presented to medical genetics at 7 months of age with a history of intrauterine growth restriction (IUGR), poor feeding, mild developmental delays, microcephaly, and dysmorphic facial features. Whole exome sequencing revealed a novel c.1464 T>G (p.Cys488Trp) variant in the IGF1R gene, initially classified as a variation of uncertain significance (VUS). We enrolled the patient in URDC (Undiagnosed Rare Disease Clinic) and performed additional studies including deep phenotyping and familial segregation analysis, which demonstrated that the patient's IGF1R VUS was present in phenotypically similar family members. Furthermore, biochemical testing revealed an elevated serum IGF1 level consistent with abnormal IGF1 receptor function. Work-up resulted in the patient's variant being upgraded from a VUS to likely pathogenic. Our report expands the variant and phenotypic spectrum of IGF1R-related disorders and illustrates benefits and feasibility of reassessing a VUS beyond the initial molecular diagnosis by deep phenotyping, 3D modeling, additional biochemical testing and familial segregation studies through URDC, a multidisciplinary clinical program whose major goal is to end the diagnostic odyssey in patients with rare diseases.

Purpose: To consolidate the evidence from the available literature and undertake a meta-analysis to provide a reference for physicians to make evidence-based recommendations to their patients regarding the return to driving after hip or knee arthroscopic procedures. Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The OVID, Embase, and Cochrane databases were searched through June 2020 for articles containing keywords and/or MeSH (Medical Subject Headings) terms "hip arthroscopy" and "knee arthroscopy" in conjunction with "total brake response time" or "reaction time" in the context of automobile driving. A title review and full article review were performed to assess quality and select relevant articles. A meta-analysis of qualifying articles was undertaken. Results: Eight studies met the inclusion criteria for meta-analysis of brake reaction time (BRT). Meta-analysis of all knee BRTs showed times slower than or equal to baseline BRTs through 5 weeks, with a trend of improving BRTs from 6 to 10 weeks (weeks 8 and 10 were significant, P < .05). Among all hip BRTs, week 2 showed times slower than baseline BRTs, but after week 4, a trend toward faster BRTs was observed through week 8 (week 8 was significant, P < .05). Conclusions: BRTs met baseline or control values and continued to improve after 6 weeks after knee arthroscopy and after 4 weeks after hip arthroscopy. On the basis of these results, it would be safe to recommend a return to driving at 6 weeks after knee arthroscopic procedures and 4 weeks after hip arthroscopic procedures. Clinical Relevance: These results can be used by surgeons to base their recommendations on to provide guidance for their patients on the resumption of driving. Although BRT is an important aspect of driving ability, there are additional factors that need to be taken into consideration when making these recommendations, including cessation of opioid analgesics, strength of the surgical limb, and range of motion.H ip and knee arthroscopies are some of the most common orthopaedic procedures performed. Studies in the United States have suggested that 70,000 hip arthroscopies are performed annually, with a further 984,607 knees arthroscopies. 1,2 Such procedures have many advantages over their open-procedure counterparts, such as less postoperative swelling, reduced pain, faster recovery time, and reduced risk of complications. 3 Arthroscopy is available for the treatment of a wide variety of orthopaedic conditions, including anterior cruciate ligament (ACL) reconstruction, meniscectomy, labral repair, femoroacetabular

Background: Hip and knee arthroscopies are common orthopaedic procedures. As patients are looking to return to their regular schedules and regain their independence post-surgery, physicians often encounter the question of, “when can I drive again?” While safety of the patient is of the utmost importance when making these recommendations, it is equally important to consider the possibility of harm to others and potential legal ramifications. The purpose of this study is to consolidate evidence from available literature and undertake a systematic review and meta-analysis to determine when it is safe for patients to return to driving after hip and knee arthroscopic procedures.  Methods:  A systematic review was conducted using PRISMA guidelines. OVID, EMBASE, and COCHRANE databases were searched through June 2020 for articles containing keywords and/or MeSH terms “Hip arthroscopy” and “knee arthroscopy” in conjunction with “total brake response time” or “reaction time” in the context of automobile driving. Title review and full article review were done to assess quality and select relevant articles. Review Manager Version 5.4 was utilized for statistical analysis.   Results: 8 papers were included in the meta-analysis of Brake Reaction Time (BRT). Meta-analysis of all Knee BRTs showed times slower-than or equal-to-baseline BRTs through 5 weeks, with a trend of improving BRT from 6 to 10 weeks (only weeks 8 and 10 were significant P < 0.05). Of all Hip BRTs, week 2 showed slower-than-baseline BRTs, but after week 4 demonstrated a trend toward faster BRTs through week 8 (only week 8 was significant P < 0.05).   Conclusion: BRTs met baseline/control values and continued to improve after 6 weeks following knee arthroscopy and after 4 weeks following hip arthroscopy. Based on these results it would be safe to recommend return to driving at 6 weeks after knee arthroscopy and 4 weeks after hip arthroscopic procedures.