Most patients undergoing fast-track hip and knee arthroplasty resumed driving within 6 weeks, with a median return of 4 weeks following medial unicompartmental knee arthroplasty (mUKA) or left-sided surgery, compared with 6 weeks following total hip or total knee arthroplasty and right-sided surgery.
Researchers conducted a single-center prospective cohort study of patients undergoing primary unilateral total hip arthroplasty (THA), total knee arthroplasty (TKA), ormUKA in a fast-track program at Odense University Hospital in Denmark from September 2022 to July 2023. Patients underwent early mobilization on the day of surgery, and at least 30% were discharged the same day. Questionnaires were distributed to 408 patients 3 to 12 months following discharge; 357 responded, for an 88% response rate. After 51 patients without a driver's license were excluded, the analysis included 306 patients: 134 who underwent THA, 103 who underwent TKA, and 69 who underwent mUKA.Patients were advised that driving could resume once they could safely operate a vehicle without functional impairment of the operated limb and were no longer under the influence of opioids.
Researchers assessed time to driving resumption, factors associated with a delay beyond 6 weeks, and self-reported postoperative traffic incidents.
Within 2 weeks, 13% of patients who underwent THA, 11% who underwent TKA, and 28% who underwent mUKA had resumed driving. By 6 weeks, the corresponding proportions increased to 77%, 65%, and 80%. Median time to driving resumption was 6 weeks following THA and TKA compared with 4 weeks following mUKA.
Driving resumption also differed by surgical side. Within 2 weeks, 22% of patients with left-sided surgery had resumed driving compared with 8% of those with right-sided surgery. Median time to resumption was 4 weeks following left-sided surgery compared with 6 weeks following right-sided surgery.
Female patients had 2.8 times the odds of delayed driving resumption beyond 6 weeks compared with male patients. Age, arthroplasty type, surgical side, frailty, preoperative psychiatric medication use, and preoperative opioid use were not statistically significantly associated with delayed driving in the adjusted analysis.
Postoperative traffic incidents were infrequently reported, with 2 patients, or 0.7%, reporting an automobile traffic incident following surgery. However, driving performance was not objectively assessed, and the low number of reported incidents does not establish the safety of earlier driving.
The study had several limitations. Driving resumption was self-reported 3 to 12 months following discharge, introducing potential recall bias. The researchers also identified insufficient information on preoperative driving habits and experience as a limitation. Small subgroup sizes and the inclusion of multiple variables increased uncertainty in analyses of factors associated with delayed driving. Differences between patient groups that were not fully captured in the study may have contributed to the earlier return observed following mUKA, and selection bias could not be excluded. Patients without access to the required digital mailbox were also excluded, potentially limiting generalizability. Existing clinical practice and knowledge suggesting a 6-week postoperative recovery period may also have influenced when patients chose to resume driving.
The findings, according to the researchers, suggest that postoperative driving recommendations may need to account for individual functional recovery rather than a fixed recovery interval. However, the study did not objectively assess driving performance, leaving uncertainty about whether earlier driving resumption is safe following different arthroplasty procedures.
“In perspective, our findings demonstrate that it may be feasible and safe to resume driving within a few weeks following hip and knee arthroplasty. However, driving is a complex skill, and patient recommendations should be individualized based on a comprehensive assessment,” wrote lead study author Oddrún Danielsen, of the Department of Orthopaedic Surgery and Traumatology at Odense University Hospital and the Orthopedic Research Unit, Department of Clinical Medicine at the University of Southern Denmark, and colleagues.
The Center for Fast-Track Hip and Knee Replacement received funding from the Novo Nordisk Foundation to facilitate its organizational setup. Danielsen's salary was supported by the Candys Foundation, University of Southern Denmark, and Region of Southern Denmark. Complete author disclosure-of-interest forms are available with the article.
Source: Acta Orthopaedica
