Joint diseases in the lower limb with an influence on driving

Lower limbs are indispensable for driving. Any change, even if apparently insignificant, may have an impact by limiting or impairing adequate pedal control.

Degenerative joint diseases

Epiphyseal coxa vara causes a waddling gait, thigh and knee pain, and marked limb shortening, with limited abduction and medial rotation. Surgical treatment is required.
Post-traumatic necrosis of the femoral head has a variable and prolonged course, and treatment ranges from rest to surgery.
Osteochondritis dissecans of the hip, knee, and patella causes joint block, with sudden extension limitation, that spontaneously resolves with motion.
Repetition causes joint effusion. Mild pain initially occurs in the hip, but subsequently becomes severe and greatly limits motion.
Patellar chondropathy is common in adolescents and causes pain and recurrent joint effusion, preventing moped driving, and often worsens when using the starting pedal
Osgood-Schlatter occurs in young people, causing pain that prevents bicycle riding. Limb rest is required
Osteoarthritis deformans of the hip and knee is a condition progressing with age that causes significant pain and joint restriction. Joint effusion frequently occurs.
Neurogenic joint diseases in conditions where deep sensitivity is lost, such as syringomyelia or myelitis due to spinal cord lesions, cause progressive and deforming trophic changes in the joints.
The disorder usually involves a whole limb, and is due to prolonged trauma to a painless joint.
Instability, dancing joint, subluxations, and possibly condyle and joint cartilage detachment occur.
Haemophilic haemarthrosis arises as the result of minor trauma due to joint bleeding from the synovium in haemophilia A and B.
The preferential location is the knee, where a significant cartilage lesion with joint deformation results.

Tips

While the patient has pain, loss of strength, and functional limitation preventing adequate use of the car pedals, driving should not be permitted.
Pain prevents movements that are essential when driving, thus causing uneasiness, fatigue, worry, insecurity, and loss of attention. Driving becomes an obligation that worsens the clinical picture.
Loss of deep sensitivity in neurogenic joint diseases prevents driving, and patients should be adequately informed of this.
Joint stiffness impairs multiple movements required for pedal action, thus preventing a rapid response to unexpected traffic situations.
Pain and motion restrictions may lead the physician to advise against driving.
Depending on the required treatment and existing sequelae, the specialist will determine in each case the ability to drive of the patient and will report it at each revision.
Surgical treatment requires in each case a subsequent functional recovery and safety period in which driving will not be allowed until a favourable report is issued by the specialist.
Patients cannot drive with a bandaged or immobilised lower limb.
Patients must not drive while they have symptoms that may impair safety.
Permanent disabilities may be evaluated based on the specialist report to try and adapt the vehicle to the driver and permit driving with the restrictions imposed by law for each case.

Inflammatory joint diseases

Infectious arthritis of the hip and knee causes pain, effusion, and functional impotence. Depending on the causative bacteria and time since the start of infection, it may be complicated by a severe joint empyema.
Gouty arthritis induces severe pain with local reddening and swelling. The first toe is more commonly involved.

Tips

Driving is not possible during the acute episode.
While the patient has pain, loss of strength, and functional limitation preventing adequate use of the car pedals, driving should not be permitted.
Pain and motion restrictions may lead the physician to advise against driving.
Patients cannot drive with a bandaged or immobilised lower limb.
Depending on the required treatment and existing sequelae, the specialist will determine in each case the ability to drive of the patient and will report it at each revision.

Tumour joint diseases

Synovial chondromatosis of the hip causes joint cracks and marked joint restriction. Treatment is symptomatic, and surgery is only required in very advanced cases.
Capsular osteoma and synovial sarcoma are malignant and invasive tumours, easily relapse, and require limb amputation in some cases.
Other joint tumours include fibroma, lipoma, haemangioma, and lymphangioma, which require surgical excision when causing joint restriction.

Tips

Functional lower limb limitations often prevents driving.
Depending on the required treatment, the specialist will determine in each case the ability to drive of the patient and will report it at each revision.
Whenever required, the physician may advise against driving until clinical improvement allowing the patient to drive safely has occurred.
Surgery requires a more or less prolonged period in which utmost care should be exercised to achieve adequate recovery of functional capacity.
Driving after a limb amputation as treatment for some cases of malignant tumours requires adequate vehicle adaptation according to legal regulations, and a learning period in the new conditions.