By Saumya Joseph
(Reuters Health) – After knee- or hip-replacement surgery, most patients return to driving within about four weeks – much quicker than some current recommendations, according to a U.S. study.
Recent advances in surgical techniques and anesthesia have helped accelerate rehabilitation time, and past practices of advising patients to wait six or eight weeks before driving may no longer apply, the study team concludes in the Journal of the American Academy of Orthopaedic Surgeons.
“We have guidelines and recommendations for all patients as to when they could return to driving after their knee or hip replacement,” said Dr. Alexander Rondon of the Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia, who led the study. “But the real reason (behind the study) was we wanted objective data. When do they actually return and why?”
The National Highway Safety Traffic Administration recommends a three-to-four-week waiting period. Some studies have found that it can take four to eight weeks for braking-response time to return to normal, the study team writes.
To examine when patients actually return to driving, what factors might predict the timing, and whether safety is impaired with shorter wait periods, Rondon’s team looked at data on 1,044 patients.
All participants had either knee- or hip-replacement surgery in 2017 or 2018 and filled out an electronic survey every two weeks for three months following the procedure.
Patients were instructed to return to driving after they were off pain medication and could comfortably move their leg from side to side, but their surgeons did not specifically provide a time frame for a return to driving.
On average, patients returned to driving 4.4 weeks after knee replacement and 3.7 weeks after hip replacement.
For their calculations, the researchers established a baseline, or earliest possible return to driving, of about 11 days for knee surgery patients and 17 days for those who had hip surgery.
A variety of factors added to that time. For instance, right-sided procedures added about two days more to the baseline.
Use of a cane or walker before surgery, and post-surgery pain, limited range of motion, not feeling safe to drive, discharge to a rehabilitation facility, limited ability to brake, and other factors predicted longer periods before returning to driving, researchers also found.
Most surgeons do not stick to the recommendation of waiting six weeks, and instead provide a general guideline, letting patients decide when to get back on the road, noted Dr. Michael Alexiades, a hip and knee surgeon at the Hospital for Special Surgery in New York City who wasn’t involved in the study.
“A lot of surgeons hesitate to give patients a definitive time to return to driving,” he said, adding there have been cases where surgeons were sued by patients who got into accidents after resuming driving within the time period recommended to them.
Just seven patients, or 0.7% of the study group, got into accidents after returning to driving within 12 weeks after surgery, but there were no reported injuries, Rondon’s team found.
The surgical approach used for patients also had a significant influence on the time taken to return to driving, the authors note. Patients who had surgeries that approached the hip from the front, on average, returned to driving within a little over three weeks, compared with nearly four weeks among those who had surgeries that involved the side or back of the hip.
Only 19 patients did not get back to driving within 12 weeks of surgery.
“The reality of the situation is they’re driving earlier today than what is recommended, but the question as to whether they are truly ready to return to driving in that time period still has to be answered,” Alexiades said.
SOURCE: https://bit.ly/2p7ktJv Journal of the American Academy of Orthopaedic Surgeons, online September 18, 2019.