Osteoarthritis Impairs Driving Abilities

Background

Osteoarthritis affects millions of people worldwide and is the most common form of arthritis. (1)

The worldwide estimates suggest that 9.6% of men and 18% of women 60 years have symptomatic osteoarthritis (2)

However in the US, 52.5 million (22.7%) of adults aged ≥18 years had self-reported doctor-diagnosed arthritis, and 22.7 million (9.8%, or 43.2% of those with arthritis) displayed arthritis-attributable activity limitation that matched and exceeded previous projected increases, respectively. (3)

Very often the disease affects the middle-aged and elderly, although younger people can also be affected as a result of injury or overuse.

The strongest predictor for the diseases is age and as a result of increasing age and extended life expectancy, this will result in a greater occurrence of the disease.

Patients afflicted with this disease suffer from loss of function and pain. (4)

Protective cartilage on the ends of a person’s bones wears down over time.

While osteoarthritis can damage any joint in your body, it most commonly affects joints in your hips, knees, hands and spine.

Usually the symptoms of Osteoarthritis may be effectively managed, although generally the underlying process cannot be reversed.

It is very important to stay active, maintain a healthy weight and there are other treatments that may slow progression of the disease and help to improve pain and joint function.

Symptoms

The symptoms of Osteoarthritis often develop slowly and worsen over time

Signs and symptoms of osteoarthritis may include:

• Pain 
• Tenderness 
• Stiffness
• Loss of flexibility
• Grating sensations
• Bone Spurs

Causes

The disease occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates.

In the normal healthy body cartilage is the firm, slippery tissue that permits almost frictionless joint motion.

However patients with osteoarthritis that used to have the slick surface, the cartilage now becomes rough.

Ultimately, if the cartilage wears down completely, you may experience the very painful process of bone rubbing on bone.

Risk factors

Factors that may raise your risk of osteoarthritis include:

• Older age
• Sex with osteoarthritis occurring more commonly in women
• Obesity
• Joint injuries
• Certain occupations where there are repetitive use of the same joint.
• Genetics
• Bone deformities.

Complications

Because Osteoarthritis is a degenerative disease that worsens over time, the joint pain and stiffness may become so severe that daily tasks become difficult to perform.

Some individuals are no longer able to work.

When joint pain is very severe, joint replacement surgery may be necessary.

Diagnosis

A physical examination is conducted by a physician who will closely examine the affected joint, check for tenderness, swelling or redness, and for range of motion in the joint.

They may also recommend imaging and lab tests.

Imaging tests

Pictures of the affected joint can be obtained during imaging tests that may include:.

• X-rays
• Magnetic resonance imaging (MRI)

Lab tests

When joint fluid or blood is analysed it may help confirm the diagnosis.

• Blood tests can rule out conditions like rheumatoid arthritis

• Joint fluid analysis may be utilised to see if there is inflammation and if pain is caused by gout or an infection

Treatment

Lifestyle changes along with physical and other therapies, drugs and surgery may be helpful

The most beneficial treatment is to exercise and to maintain a healthy weight

Medications

Drug therapy that can help includes:

• Acetaminophen
• Nonsteroidal anti-inflammatory drugs ( NSAIDs)
• Duloxetine

Therapy

• Physical therapy
• Occupational therapy
• Tai chi and Yoga

Surgical and other procedures

If conservative treatment is not providing sufficient help then consider:

Cortisone injections

Lubrication injections

Realigning bones

Joint replacement

Alternative medicine

Different complementary and alternative medicine can help with osteoarthritis symptoms.

Treatments that have been beneficial include:

Acupuncture. Pain may also be relieved with improved function in people who have knee osteoarthritis.

Glucosamine and chondroitin might be beneficial but interactions may occur with blood thinners like warfarin to cause bleeding problems.

Avocado-soybean unsaponifiables may slow down or prevent joint damage.

Lifestyle and home remedies may include items such as an ergonomic knife.

• Exercise
• Lose weight
• Use of heat and cold to manage pain
• Capsaicin. Topical capsaicin may be beneficial if consistently applied 3 to 4 times a day for several weeks
• Apply over-the-counter pain creams
• Braces or shoe inserts. Your physician may suggest shoe inserts or other devices that can help reduce pain when you stand or walk.                                              
• These devices may immobilize or support your joint to help take pressure off it.
• Knee taping. Strapping tape may help reduce the pain of knee osteoarthritis.

Use assistive devices such as a cane in the hand opposite the leg that hurts.

Coping and support

A person’s outlook on life may be a significant factor to managing pain and disability.

The ability to cope despite pain and disability caused by osteoarthritis frequently determines how much impact osteoarthritis will have on your everyday life.

If feeling frustrated talking to your physician may be beneficial because they may have ideas about how to cope or refer you to someone who can help.

Does Osteoarthritis of the Knee or Hip significantly Impair Driving Ability?

UK Hoffman and colleagues hypothesised that osteoarthritis (OA) which is the most frequent reason for arthroplasty, already compromises the ability to perform an emergency stop. (5)

They hypothesised that both Reaction Time (RT) and Movement Time (MT) as components of the Total Brake Response Time (TBRT), would be extended in patients with OA of the knee or hip in compared to healthy individuals.

Furthermore, they expected maximum pressure levels on the brake pedal to be reduced in these cases.

METHODS

The researchers utilised a real car cabin that was equipped with pressure sensors on the accelerator and brake pedals to measure RT, MT, TBRT and maximum Brake Force (BF) under realistic spatial constraints.

Patients with Osteoarthritis of the knee (right n = 18, left n = 15) or hip (right n = 20, left n = 19) were compared with a healthy control group (n = 21).

RESULTS

The authors found that all measured values for TBRT in the control group remained below 600 ms.

Osteoarthritis of the right hip or knee significantly prolonged the braking performance (right hip: TBRT p = 0.025, right knee: TBRT p < 0.001), however OA of the left hip did not impair driving ability (TBRT p = 0.228).

Interestingly, OA of the left knee prolonged RT and MT to the same extent as OA on the contralateral side (RT p = 0.001, MT p < 0.001).

CONCLUSIONS

This important research demonstrated that depending on the localisation of OA, driving capability may can be impaired; OA can significantly increase the total braking distance.

Furthermore to ensure safe traffic participation the safety margin for TBRT should be strictly set, under the experimental conditions of around 600 ms.

Therapeutic approaches to OA, such as physiotherapy, and patients receiving surgery of the left knee should take into consideration that left knee OA may also impair driving ability.

How Does Radiographic Evidence of Hip or Knee Osteoarthritis Affect the Ability to Drive?

Last month M Von Bernstorff and fellow researchers studied the braking performance of 158 patients with OA of the right or left knee or hip and compared the results with radiographic OA grading according to the Kellgren-Lawrence classification scale.(6)

They measured Reaction time and foot transfer time (together called brake response time [BRT]) and brake force in a real car cabin, and the values were compared with measurements obtained from young (n=34) and age-matched (n=36) control groups.

The authors found that the majority of BRTs in both control groups remained below 600 milliseconds.

However patients with both hip and knee OA, whether on the right or left side, had significantly worse values (P<.001) and frequently exceeded this limit.

A stronger impact was found on the right side and in knee OA, with the poorest results found in patients with bilateral OA (median BRT for bilateral hip OA, 656 milliseconds [range, 468-1459 milliseconds]; median BRT for bilateral knee OA, 696 milliseconds [range, 527-772 milliseconds]), resulting in an increased total stopping distance of up to 32 m at 100 km/h.

There was no correlation observed of braking performance with radiographic OA appearance (Kendall tau for BRT: τ=0.007, P=.92; Kendall tau for brake force: τ=-0.014, P=.82), which makes radiographs not a suitable tool for medical driving recommendations.

Conclusion

Previously it has been established that aging significantly impairs reaction time for elderly people who drive motor vehicles.

A cross-sectional study conducted at Touro University California campus found that drivers aged 60 and over had very significantly impaired driver reaction times compared to those aged 18 -40 years  (510.0 ± 208.8 vs. 372.4 ± 96.1 ms, P =.0004) and also had more collisions (0.18 ± 0.39 vs. none, P =.0044).(7)

This issue is further exacerbated for patients suffering from osteoarthritis in the hips and knees with substantial additional impairment to drive a car safely.

As the population ages there will be an increasing number of patients with osteoarthritis who drive cars throughout the whole world.

This reinforces the importance of continuing to find minimally sedating drugs to reduce deaths, severe trauma injuries and property damage for those involved in motor vehicle accidents.

References

1. Mayo Clinic Staff.1998-2016 Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/osteoarthritis/home/ovc-20198248
2. Wolf AD, Pfleger B. Burden of Major Musculoskeletal Conditions. Policy and Practice. Special Theme-Bone and Joint Decade 2000-2010. Bulletin of the World Health Organization 2003, 81 (9): 646-656.
3. Center for Disease Control and Prevention. Morbidity and Mortality Weekly Report Weekly / Vol. 62 / No. 44 November 8, 2013
4. Saloni Tanna.Osteoarthritis, Opportunities to Address Pharmaceutical Gaps. 7 October 2004.P 6.12-3
5. Hofmann UK, Jordan M, Rondak I, Wolf P, Kluba T, Ipach I. Osteoarthritis of the knee or hip significantly impairs driving ability (cross-sectional survey). BMC Musculoskelet Disord. 2014 Jan 17; 15:20. doi: 10.1186/1471-2474-15-20.
6. Von Bernstorff M, Feierabend M, Jordan M, Glatzel C, Ipach I, Hofmann UK. Radiographic Hip or Knee Osteoarthritis and the Ability to Drive. Orthopedics. 2016 Sep 19:1-8. doi: 10.3928/01477447-20160915-05. [Epub ahead of print]
7. Doroudgar S, Chuang HM, Perry PJ, Thomas K, Bohnert K, Canedo J. Driving performance comparing older versus younger drivers. Traffic Inj Prev. 2016 Jun 21:1-6. [Epub ahead of print]

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