Hip Replacement When Can You Start Driving Again
When do patients drive afterwards minimally invasive inductive hip replacements? A single surgeon experience of 212 hip arthroplasties
Ashish Batra
Ozorthopaedics, Melbourne, VIC Commonwealth of australia
Sophia Gogos
Ozorthopaedics, Melbourne, VIC Australia
Ikram Nizam
Ozorthopaedics, Melbourne, VIC Australia
Received 2022 Jul 20; Accepted 2022 Sep 16.
Abstract
Introduction: Patients desire to return to normal activities soon after hip arthroplasty, with driving ofttimes beingness an integral component. We aimed to make up one's mind when patients resumed driving post-obit a minimally invasive anterior bikini hip replacement and when they returned to piece of work.
Methodology: All consecutive patients undergoing elective primary bikini hip replacements betwixt January 2022 and April 2022 were included in the report. Patients who did non drive were excluded. A detailed questionnaire was sent to patients iii–six weeks afterward surgery to record their driving status. 50 patients were randomly selected to assess flexion at the hip, genu and talocrural joint joints while seated in the commuter'due south seat of their own vehicle.
Results: Birthday 212 inductive bikini full hip replacements (L = 102, R = 108 and 1 bilateral i phase) were performed in 198 patients (F = 129 and One thousand = 69) with a mean age of 69 years. A total of 76% patients returned to driving within the first 3 weeks after surgery, of which 25 (xiv%) resumed driving within the first post-operative week, 71 (39%) in the second week and 42 (23%) in the third week. Amid them, 98.four% stated they were confident when they first started driving and ninety.66% stated they were more than comfortable driving afterward surgery than earlier. Employed patients returned to piece of work within i–79 days (mean = 24 days).
Decision: Surgeons may allow patients to resume driving inside i calendar week afterwards anterior hip replacement and return to work within 3 weeks if they are medically fit and deemed safe.
Key words: Driving resumption, Direct anterior approach, Total hip arthroplasty, Enhanced recovery, Minimally invasive.
Introduction
The primary goals of total hip arthroplasties (THAs) are to relieve pain, improve quality of life and restore mobility [1], determined past the longevity of prosthesis [2] and early return to pre-morbid activities. Prompt resumption of driving [3] is an important surrogate marker of success. To date, there is a lack of medical and legal guidelines regarding the timeline for safety resumption of driving following THA [4]. Current literature reports a minimum vi–8-week period before patients can safely resume driving; however, this is based on outdated studies using posterior THA approaches, where half dozen–viii-calendar week waits are recommended for soft tissue recovery [5,6]. More recently, studies of anterior hip replacements have reported early return to activities [5,7–9], with one study recording brake reaction times reporting a return to preoperative values past day two post-obit microinvasive THA. With the advent of the latter technique, patients may be able to resume driving earlier than the previously recommended 6–viii weeks post-operation [10]. With the direct anterior interneuromuscular approach, patients should be able to resume normal activities, including driving, sooner than previously reported and with greater comfort than preoperatively.
The primary aim of this report was to make up one's mind when patients first resumed driving without hurting following our soft-tissue sparing bikini hip arthroplasty (BHA) [11]. The secondary aim was to determine how soon patients returned to work later anterior THA.
Methodology
All consecutive patients who underwent constituent soft-tissue sparing master bikini anterior hip replacements [11] by a single surgeon in one institution between January 2022 and April 2022 were included. Informed consent was obtained from patients and the study was approved by the local institutional review lath. Non-driving patients, those who had their arthroplasty performed using a different approach, who underwent THAs for acute neck of femur fractures and revision THAs were excluded from the written report (n = 21). All patients were treated with the same operative technique, perioperative intendance and post-operative rehabilitation protocol with early mobilisation and discharge to maintain uniformity [7,11].
Patient demographics including age, sexual activity, BMI, hip pathology and operative side were recorded prospectively (Table 1). A detailed questionnaire (Appendix 1) was sent to all patients who underwent a BHA between January 2022 and April 2018, 3–half-dozen weeks subsequently their process. Patients were reviewed two weeks post-operation and again at six–8 weeks post-operation. Their driving status at both reviews was recorded in the patient notes.
Table i
Patient demographics.
| Characteristic | N = 198 | % |
|---|---|---|
| Age (years) | ||
| Hateful | 69 | |
| Range | 46–91 | |
| BMI | ||
| Mean | 28.x | |
| Range | 17.63–56.44 | |
| Gender | ||
| Female person | 129 | (65.2) |
| Male | 69 | (34.8) |
| Functioning | ||
| Right THA | 108 | (51.23) |
| Left THA | 102 | (48.3) |
| Bilateral THA | 1 | (0.47) |
| Vehicle type | ||
| Automated | 162 | (81.viii) |
| Manual | 12 | (vi.ane) |
| Unknown | 24 | (12.1) |
At the 2-week mail service-operative review, 50 patients from the study were randomly selected to assess flexion at the hip, knee and talocrural joint joints while seated in the commuter's seat of their ain vehicle. Randomisation was performed via patient surnames de-identified and entered into a random number generator. A smaller patient sample was used to appraise articulation flexion due to the increased complexity of undertaking assessments across multiple institutions and limitations of necessary equipment and personnel.
Two measurements of flexion of each joint were recorded with the patient seated in their personal vehicle. Measurements were taken with a goniometer past one research assistant at a unmarried engagement. An average of the 2 measurements at each articulation was calculated to minimise random fault and ensure values were representative of respective joints.
Surgical procedure
All operations were performed using BHA technique previously described [11], which included both cemented (CPCS Smith and Nephew, Memphis TN) and un-cemented femoral components (Polar Smith and Nephew AG, Baar, Switzerland). Femoral caput (Oxinium Smith and Nephew, Memphis TN) sizes used included 28 mm (1.5%), 32 mm (72.v%) and 36 mm (26%). The femoral head size was determined by loving cup size. Acetabular shells of 48 mm (Acetabular shell: R3 three-pigsty HA-coated Smith and Nephew Memphis, TN) were used for femoral heads less than or equal to 28 mm in diameter. Larger femoral heads (>36 mm) were encased in 52 mm shells. Skin closure was accomplished using Monocryl monofilament absorbable sutures and a thin Comfeel dressing applied.
Statistical analysis
Ranges and ways were calculated for all result measures using responses to the driving questionnaire distributed to patients. Correlation between resumption of driving and multiple result measures was undertaken using a chi-squared examination.
Results
In total, 138 (76%) patients returned to driving within the kickoff iii weeks after surgery, of which 25 (fourteen%) patients resumed driving inside the first post-operative week, 71 (39%) patients drove in the second week and 42 (23%) returned to driving in the third week (Effigy 1). The remaining 45 patients reported that they could take driven earlier but chose not to equally they had preferred alternatives. The primeval resumption of driving was on the 2nd mean solar day post-surgery (n = 2). There were 179 (98.35%) patients who stated that they were confident when they first resumed driving. At that place were 29 patients (13.7%) who did non return to driving within 8 weeks post-surgery, 1 patient due to medical comorbidities and the remaining 28 relied on family for transport; still, they were confident that they could take driven themselves if needed.
Patient timelines for the resumption of driving following BHA.
Although more patients with left-sided THA resumed driving in the commencement post-operative week than patients who underwent right-sided THA (northward = xiv, northward = nine, respectively), there was no significant difference in the fourth dimension taken to resume driving between operative side (10 2 = three.37, p = 0.50). About xc.66% of patients stated that they were more than comfortable driving post-surgery than before surgery every bit their arthritic hip hurting and stiffness was eliminated, thus enabling piece of cake entry and exit out of the vehicle. Over 92% were climbing stairs independently earlier driving, while the remaining patients used side rails. Nearly 82% of patients collection automated cars and 6% were manual drivers, with the remaining 12% not completing the applicative question. At that place was even so no significant correlation betwixt time taken to resume driving and manual of vehicle driven by the patient (ten ii = 0.013, p = 0.91). About 29.8% of patients were still working at the time of their performance, and the residue were retired. Of the working patients, the average number of days taken to return to their usual piece of work at whatsoever chapters was 24 days (range = 1–79 days).
About 49.5% of our patients were mobilizing well before driving without any walking aids (Table ii). Of the remaining 50.five% (92 patients), 74% (68 patients) were using one crutch merely. All patients tested the machine restriction before resuming driving, with 3.85% of all patients reporting they did non feel confident with emergency braking in the six weeks following their operation. As well, sixteen.5% of patients reported they felt pain while driving, although they also stated that the pain was mild and did non distract them. Another 1% stated they felt somewhat drowsy during their initial drive post-obit surgery and thus delayed driving for a further week. Patients were given clear instructions to avert narcotics upon resuming driving before belch from infirmary. There were no dislocations, infections or thromboembolic events in this patient group. One patient had a revision THA following a significant fall down stairs 23 days following their initial operation. There were no motor vehicle accidents (MVA) or well-nigh misses reported by patients during follow-up consultations or reported in the driving questionnaire.
Table 2
Patient responses to driving questionnaire.
| Questions asked in questionnaire | Yep | No |
|---|---|---|
| Walking aids used when resumed driving | 50.55% | 49.45% |
| Ability to climb stairs when resumed driving | 92.31% | 7.69% |
| Confident to perform emergency braking if needed | 96.15% | iii.85% |
| Confident driving the kickoff time after surgery | 98.35% | ane.65% |
| Comfort driving post-surgery as compared to pre-surgery | 91.21% | 8.79% |
| Ability to make it and out of the motorcar comfortably | ninety.66% | 9.34% |
| Pain while driving | 16.48% | 83.52% |
| Pain or discomfort as a lark from driving | 2.75% | 97.25% |
| Feelings of drowsiness or sick-prepared to proceed driving | i.10% | 98.ninety% |
The measurements of angles of flexion at hip, knee and ankle during simulated acceleration and emergency braking (Figure 2) among l patients demonstrated that ankle movements appear to affect driving more than hip and knee movements. While accelerating, patients required a range of 0–43° ankle plantar flexion; while braking, bulk of patients had their talocrural joint in 0–10° plantar flexion (Figures iii and 4). Bulk of movements while accelerating or braking are at the ankle joint, although the genu joint is predominantly engaged while braking, with 0–5° of genu extension. During emergency braking, the ankle plantar flexion range may rise to 30° as the driver uses maximal forcefulness to shrink the brake completely. Hip and knee movements required an average of 71° (66°–76°) and 53° (38°–70°) flexion, respectively, in the simulated positions. Hip adduction and internal rotation of up to 5–10° was noted when patients shifted their right lower extremity from the accelerator to the brake in automatic vehicles.
Demonstration of flexion angle measurements of hip, genu and ankle joints.
Patient in driving seat twenty-four hour period after anterior THA, with hip flexion (70°), articulatio genus flexion (45°) and talocrural joint plantar flexion (xxx°) while accelerating.
Patient in driving seat ii weeks after anterior THA with hip flexion (72°), knee flexion (xl°) and ankle in neutral position while braking.
Give-and-take
Our study demonstrates that patients were able to resume driving several days afterwards undergoing soft tissue sparing BHAs [xi]. Currently, in that location are minimal studies evaluating the resumption of driving following a total hip replacement. Our study is the largest single surgeon assay to date evaluating the actual timeline of resumption of driving post-obit anterior full hip replacements.
The American Academy of Orthopaedic Surgeons recommends a waiting catamenia of 4–viii weeks postal service-surgery before recommencing driving in an automatic machine. Current communication for drivers of transmission vehicles and patients of right-sided THA is not every bit clearly divers in the literature. In either case, patients should seek the advice of a medical professional including their treating surgeon earlier resuming driving.
A study by Qurashi et al. [10] evaluating driving after total hip arthroplasty in 100 patients ended that suspension response times (BRT) reached preoperative values by day 2 following surgery. Consequently, patients may exist able to recommence driving sooner than the previously recommended 6 week post-functioning. Ganz [12] demonstrated a render of BRT to preoperative values for right-sided THA at 4–6 weeks mail-surgery, and MacDonald and Owen [three] assessed their patients 8 weeks after surgery. For left-sided THA, both Ganz [12] and MacDonald and Owen [three] demonstrated a statistically insignificant alteration of BRT when driving was resumed in a vehicle with automatic transmission. These studies suggested that driving may be resumed equally soon as one calendar week after surgery, depending on post-operative pain.
Our patients recommenced driving from week ane after surgery. It is possible that the soft-tissue sparing operative approach with enhanced recovery program contributed to the early render to driving. Over 91% of patients reported information technology was much more than comfortable to bulldoze after surgery than earlier, as the arthritic pain and stiffness was eliminated about immediately. Our study relies on the patient'southward experience in their ain vehicle, rather than utilising an automated motorcar simulator to evaluate BRT, which does not accurately mimic natural driving conditions. Additionally, the questionnaire which was utilised comprises multiple aspects of driving activity, including entering and exiting the vehicle, braking and hurting as a lark. More chiefly, measuring hip, knee joint and talocrural joint plantar flexion angles required for acceleration and braking demonstrated that ankle movements seem to impact driving more than hip or knee movements. While accelerating, patients required a range of 0–43° ankle plantar-flexion, and while braking majority of patients take their ankle in 0–10° plantar flexion. Similarly, hip and genu movements required an average of 71° (66°–76°) and 53° (38°–70°) flexion, respectively, which facilitates the resumption of driving post-THA, if hurting is minimal.
There are no validated questionnaires pertaining to driving after joint replacements in the literature. Nosotros designed our questionnaire (Annexure i) because safety as a priority and included practical aspects patients would consider before driving. The senior surgeon immune a patient to drive only later post-operative cess if the patient was medically fit and confident, walking hurting complimentary with or without a single walking aid, able to become in and out of a car comfortably, not taking oral narcotic analgesia and if accompanied past a passenger on the first driving occasion.
A study by Abbas and Waheed [four] reported 105 of 130 patients who underwent THA were able to resume driving between week six and 8. Of the remaining 25 patients, 22 returned to driving at 12 weeks and 3 were not confident driving at 12 weeks post-THA. It was ended that the fourth dimension taken to resume driving was dependent on patient's recovery and confidence in their own ability. Due to the subjective nature of this written report, a time frame could not be applied to the full general population of THA patients. Contrary to this, we plant that 25 (14%) of our patients started driving in the start calendar week post-surgery, 71 (39%) in the second week and 42 (23%) in the third week. Two patients drove subsequently the tertiary week, simply only because they were in rehabilitation mail service-surgery, both reported they could have driven earlier. Furthermore, the majority of our patients felt confident and less apprehensive when recommencing driving, potentially due to enhanced recovery measures which were taken including the minimally invasive surgical technique, local analgesia infiltration and early on mobilisation mail-procedure. 1.65% patients stated that they were not confident to bulldoze the initial time postal service-surgery, which acquired them to delay their resumption to driving by 1–two weeks, although all eventually drove with confidence.
Previous studies evaluating the burden of large joint replacement surgery on returning to work demonstrate that in that location is a pregnant psychosocial impact of prolonged absence from piece of work post-obit hip arthroplasty [13]. Later BHA, patients were able to mobilise early on and resume driving to work, thus minimising these potential consequences of prolonged absenteeism. Although 139 patients were retired, resuming driving was important to maintain their independence and resume outdoor activities and routines, as noted by our patients in the questionnaire.
All patients were seen by a surgeon and physician post-surgery before discharge. None of our patients have directly or indirectly been involved in any motor vehicle accidents inside the half-dozen-week mail service-operative period, nor did they report whatsoever adverse events.
There is a potential recall bias that must be considered due to the time period between patients receiving the questionnaire and the engagement of their operation. However, results reported in the questionnaires were cross-referenced with clinical notes recorded at the standard ii- and 8-week post-operative appointments. Additionally, at that place was no uniformity in the blazon of vehicle assessed in the study, but this may more accurately mimic the multifariousness of automobiles including automatic, manual, SUV, sedans, trucks, driven past the general population. As ideal seating positions are dependent on patient factors such equally level of comfort, at that place were a wide range of values reported for flexion at hip and knee. Finally, our questionnaire has non been validated, although it was designed using applied and relevant questions that are hands reproducible for future research.
Conclusion
Our findings demonstrate it is feasible and rubber to resume driving inside ane week following a soft-tissue sparing anterior bikini hip replacement, irrespective of the side of surgery. Working patients returned to employment within iii weeks mail service-operative, provided they were medically fit. Patients with complex medical comorbidities and those taking narcotics should seek the communication of their treating surgeon before resuming driving or returning to work.
Appendix.
Appendix ane Driving after THA questionnaire
Notes
References
1. Hall MJ, Popovic JR (2001) National hospital discharge. Advance Data from Vital Health Statistics, No. 319, Hyattsville, MD: National Middle for Wellness Statistics. [Google Scholar]
2. Knight SR, Aujla R, Biswas SP (2011) Total hip arthroplasty: over 100 years of operative history. Orthop Rev (Pavia) 3, e16. [PMC gratuitous commodity] [PubMed] [Google Scholar]
iii. MacDonald W, Owen JW (1988) The effect of total hip replacement on driving reactions. J Bone Joint Surg Br 70, 202–205. [PubMed] [Google Scholar]
4. Abbas One thousand, Waheed A (2011) Resumption of auto driving afterwards total hip replacement. J Orthop Surg (Hong Kong) 19 (1), 54–56. [PubMed] [Google Scholar]
5. Rodriguez JA, Deshmukh AJ, Rathod PA, Greiz ML, Deshmane PP, Hepinstall MS, Ranawat AS (2013) Does the direct anterior approach in THA offering faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res 472, 455–463. [PMC free article] [PubMed] [Google Scholar]
half dozen. Peters A, Tijink M, Veldhuijzen A, Huis in 't Veld, R (2015) Reduced patient restrictions following full hip arthroplasty: study protocol for a randomized controlled trial. Trials xvi, 360. [PMC complimentary article] [PubMed] [Google Scholar]
vii. Ibrahim MS, Twaij H, Giebaly DE, Nizam I, Haddad FS (2013) Enhanced recovery in total hip replacement: a clinical review. Bone Joint J 95-B (12), 1587–1594. [PubMed] [Google Scholar]
8. Ibrahim M, Nizam I, Khan A, Haddad FS. Perioperative interventions producing ameliorate functional outcomes and enhanced recovery following total hip and knee joint arthroplasty : an evidence based review. BMC Med. 2013, eleven:37. [PMC free commodity] [PubMed] [Google Scholar]
9. Kerr DR, Kohan L (2009) Local infiltration analgesia: a technique for the command of acute postoperative pain following human knee and hip surgery: a example study of 325 patients. Acta Orthop 79 (2), 174–183. [PubMed] [Google Scholar]
x. Qurashi S, Chinnappa J, Lord SJ, et al. (2016) Driving after microinvasive total hip arthroplasty. J Arthroplasty 32 (5), 1525–1529. [PubMed] [Google Scholar]
eleven. Nizam I (2015) The bikini hip replacement: surgical technique preserving vessels and deep soft tissues in directly anterior approach hip replacement. J Orthop Res Physiother 1, 007. [Google Scholar]
12. Ganz SB (1993) Concrete therapy post-obit total hip arthroplasty In: Surgery for Rheumatoid Arthritis, Sculco TP, Editor. St Louis, Mosby, pp 381–395. [Google Scholar]
13. Malviya A, Wilson G, Kleim B et al. (2014) Factors influencing return to work after hip and human knee replacement. Occup Med 64(six), 402–409. [PubMed] [Google Scholar]
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250078/
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