Patients undergoing total knee arthroplasty (TKA) often ask when they can safely resume driving. Answering this question is an important matter, which might entail legal and insurance issues. In the present review, the following questions are addressed: What is the quality of the existing literature on this issue? When does the Brake Response Time (BRT) return to baseline values after right and left TKA? Are BRT components, reaction time (RT), and movement time (MT) equally affected after right and left TKA? Are there gender differences regarding the influence of TKA on BRT and its recovery? An electronic systematic search was performed on Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and PubMed. Ten studies investigating the effects of TKA on driving performance were included. The quality assessment was made with a 12-item assessment tool adapted from the “Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies” of the National Institute of Health. The quality of the existing studies varies, with all studies having methodological weak points. TKA causes an MT delay, which affects BRT negatively. The mean number of days for BRT to return to baseline values was 44 ± 19 (95% C.I. [29 to 58]) and 20 ± 15 (95% C.I. [2 to 38]) after right and left TKA, respectively. As shown by the wide 95% C.I. of the mean, these values can increase to higher numbers. Based on the weighted mean values, a driving abstinence of at least six weeks after right TKA and three weeks after left TKA should be recommended. Due to the discrepancies found in results, further high quality studies are necessary.
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