When Can I Drive?

Predictors of Returning to Driving After Total Joint Arthroplasty

Alexander J. Rondon, MD, MBA; Timothy L. Tan, MD; Karan Goswami, MD; Noam Shohat, MD; Carol Foltz, PhD; P. Maxwell Courtney, MD; Javad Parvizi, MD, FRCS

Disclosures

J Am Acad Orthop Surg. 2020;28(10):427-433. 

In This Article

Abstract and Introduction

Abstract

Introduction: A common question by patients considering total joint arthroplasty (TJA) is when can I return to driving. The ability to return to driving has enormous effect on the independence of the patient, ability to return to work, and other activities of daily living. With advances in accelerated rehabilitation protocols, newer studies have questioned the classic teaching of waiting 6 weeks after TJA. The goal of this prospective study was to determine specific patient predictors for return to driving and create individualized models able to estimate return to driving based on patient risk factors for both total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Methods: From July 2017 to January 2018, 554 primary TKA and 490 primary THA patients were prospectively enrolled to obtain information regarding return to driving. Patients were sent a survey every 2 weeks regarding their return to driving. Additional information regarding vehicle type, transmission, and involvement in motor vehicle accidents was collected. Bivariate analysis was done followed by the creation of a multiple linear regression models to analyze return to driving after TKA and THA.

Results: The majority (98.2%, 1,025/1,044) of patients returned to driving within 12 weeks of surgery. On average, patients returned to driving at 4.4 and 3.7 weeks for TKA and THA (P < 0.001), respectively. The rate of motor vehicle accidents was 0.7% (7/1,044) within 12 weeks after surgery with no injuries reported. After multivariate analysis, baseline return to driving began at 10.9 days for TKA and 17.1 days for THA. The following predictors added additional time to return to driving for TJA: not feeling safe to drive, limited range of motion, female sex, limitations due to pain, other limitations, discharge to a rehabilitation facility, right-sided procedures, limited ability to break, preoperative anemia, and preoperative use of a cane.

Discussion: Important predictors identified for return to driving were sex, joint laterality, limited ability to walk or ability to break, and feeling safe. Surgeons should consider these factors when counseling patients on their postoperative expectations regarding driving after TJA.

Introduction

"When can I drive?" is one of the most commonly encountered questions from the patient perspective before total joint arthroplasty (TJA). The answer to this pertinent question is not always easy as many variables affect the patient's ability to drive after TJA. Surgeons often combine their knowledge and clinical experience to provide information related to this issue to the patients.

The national highway traffic safety administration recommends patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) wait at least 3 to 4 weeks before safely returning to driving.[1] However, these recommendations have not been based on any studies, and no proof that delaying the return to driving reduces the potential for accidents for TJA patients is found.[1,2] Several studies have reviewed brake response time as a proxy for safely of returning to driving after TJA and suggested a timescale of between 4 and 8 weeks before returning to driving.[3–5] However, to the best of our knowledge, no studies have specifically investigated the predictors of return to driving.[2,3,6]

The lack of published work in this area is largely because that this information needs to be obtained prospectively due to recall bias. The purpose of this prospective study was to determine how quickly patients could safely return to driving after TJA. After controlling for confounding demographic, medical, and social variables, we also sought to identify independent risk factors for prolonged return to driving after both THA and TKA. We hope the results of our study can provide valuable information for surgeons when counseling their patients about driving after TJA.

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