Driving after surgery: Getting back behind the wheel safely

The decision to return to driving after surgery, or after orthopedic trauma, is not only a matter of safety, but also has legal ramifications. Patients often have this question before or after a surgery, as the limitation of driving is a big obstacle in their daily life. Unfortunately, there are many who return to driving after surgery without consulting a doctor, still under the influence of painkillers (often opiates), or still wearing a splint or cast.

Despite the crucial role that driving plays in our daily lives, there are still no clear and commonly accepted guidelines regarding the ideal timing of returning to driving after surgery. 

Driving after surgery - Relevant studies 

Maintaining the ability to brake quickly and effectively in an emergency is perhaps the most important factor in ensuring safe driving. Most studies in the international literature focus on measurements of this kind in special simulators:

• Breaking response time, or BRT: the time that elapses from the appearance of an obstacle to contact with the brake pedal.
• Total braking time, or TBT: the time from the appearance of the obstacle until the driver fully depresses the brake pedal.

Unfortunately, the resulting results are often heterogeneous and conflicting, without drawing firm conclusions. The existing tests are also not standardized, resulting in differences regarding the side of the steering wheel or the type of clutch. The available systematic reviews and meta-analyses offer some rough guidelines for the treating surgeon to consider.

Patient approach for safe return to the wheel

Given the lack of clear guidelines, most surgeons allow return to driving after surgery once the patient is no longer immobilized, has no need for pain medication, can fully weight-bearing the operated lower extremity, or when has full strength in the operated upper extremity. A practical piece of advice, often given by doctors, is to take a few test drives in a controlled environment without heavy traffic, to test your strength and make sure you have complete control of the vehicle.

Legal implications

The current legislation is not clear about returning to driving after surgery, which makes individualization necessary. Many times, insurance companies also do not have a clear policy and will place the responsibility for the return to driving decision on the doctor or patient in order to avoid potential legal liability. Many doctors for the same reason may appear reluctant to express an opinion, or postpone the final decision until later.

Listed below are indicative times to return to driving after surgery, categorized by type of surgery, based on existing studies. Of course, these values ​​are not a panacea, and the decision to safely return to driving should be individualized taking into account each individual's circumstances.

In any case, the patient under scrutiny should:

• have regained full range of motion of the overlying and underlying joint.
• Να έχει ανακτήσει το πλήρες εύρος κίνησης της υπερκείμενης και υποκείμενης άρθρωσης.
• have no pain and have completely stopped using opioids.

Upper limb surgery

• Shoulder Arthroscopy with repair of a rotator cuff tear: 6-12 weeks, or 2 weeks according to more recent studies.⁶
• Shoulder Arthroscopy with no repair (ie, subacromial decompression for impingement syndrome): 1 month after surgery.⁶
• Shoulder Arthroplasty (anatomic or reverse arthroplasty): 6-12 weeks.⁷
• Median nerve decompression for carpal tunnel syndrome: 9 days.⁵
• Internal fixation for distal radius fractures: 3 weeks.⁸

Lower limb surgery

• Simple knee arthroscopy, ie for meniscectomy: 1 week.⁹
• Knee Arthroscopy for ACL tears: 3-6 weeks, depending on graft type.¹⁰
• Total knee arthroplasty: 2-8 weeks.¹
• Total hip arthroplasty: 2-6 weeks.¹
• Ankle Fractures: 9 weeks after surgery, or 6 weeks after initiating full weight-bearing.¹¹
• Intramedullary nailing of the tibia or femur : 12 weeks after surgery, or 6 weeks after initiating full weight-bearing.¹²

The use of braces of the lower extremities adversely affects braking ability and drivability, making it prohibitive. Upper limb braces or splints of various kinds do not affect the ability to brake, but have a negative effect on the ability to avoid a sudden obstacle. The National Highway Traffic Safety Administration states that drivers should have at least 4/5 of their upper extremity and right lower extremity strength as the minimum allowable limit for driving (Oxford Scale – 4/5 : movement of the leg against gravity and some small resistance).

When can I return to driving after surgery?

From the above, it can be seen that there are still no clear rules for when we can safely return to driving after surgery. Every patient is different and some will get back behind the wheel faster than others. Be that as it may, there are some general tips that we can follow in all cases:

• We should seek the consent of our surgeon. The doctor's decision will depend on the type of surgery we underwent, possible co-morbidities, the stage of recovery and other personal circumstances, such as the type of vehicle we usually drive.
• We should inform our insurance company and know their policy in order not to be legally liable.
• Before we can go back to driving, we should be fully recovered from our surgery.
• We should not have pain, which can easily distract us from the road, but also not be under the influence of opiates or other analgesic drugs, which can prevent us from being 100% focused on driving.
• We should sit comfortably in the driver's seat and have full control of the vehicle without pain, but also be able to make an emergency stop or a sudden change of direction without this may cause us pain or damage our surgical incision.
• It is better to avoid long trips, and start with short routes, close to home.
• Ultimately, it is our responsibility to make sure that we are in full control of our vehicle at all times, and we should be confident enough to demonstrate this, if asked.

References

1.     Marecek GS, Schafer MF. Driving after orthopaedic surgery. J Am Acad Orthop Surg. 2013 Nov;21(11):696-706. doi: 10.5435/JAAOS-21-11-696. PMID: 24187039.

2.     DiSilvestro KJ, Santoro AJ, Tjoumakaris FP, Levicoff EA, Freedman KB. When Can I Drive After Orthopaedic Surgery? A Systematic Review. Clin Orthop Relat Res. 2016 Dec;474(12):2557-2570. doi: 10.1007/s11999-016-5007-9. Epub 2016 Aug 4. PMID: 27492688; PMCID: PMC5085934.

3.     Venugopal NK, O’Leary S, Robledo A, Husain A, Tom RB, Nuti SA, Jupiter DC, Panchbhavi VK. Safe driving recommendations following lower extremity orthopedic surgery: a systematic review. Eur J Orthop Surg Traumatol. 2023 Aug 28. doi: 10.1007/s00590-023-03705-9. Epub ahead of print. PMID: 37639004.

4.     MacKenzie JS, Bitzer AM, Familiari F, Papalia R, McFarland EG. Driving after Upper or Lower Extremity Orthopaedic Surgery. Joints. 2019 Feb 1;6(4):232-240. doi: 10.1055/s-0039-1678562. PMID: 31879720; PMCID: PMC6930129.

5.     Acharya AD, Auchincloss JM. Return to functional hand use and work following open carpal tunnel surgery. J Hand Surg [Br] 2005;30(06):607–610.

6.     Hasan S, McGee A, Weinberg M, et al. Change in driving performance following arthroscopic shoulder surgery. Int J Sports Med 2016;37(09):748–753.

7.     Hasan S, McGee A, Garofolo G, et al. Changes in driving performance following shoulder arthroplasty. J Bone Joint Surg Am 2016;98(17):1471–1477.

8.     Jones EM, Barrow AE, Skordas NJ, Green DP, Cho MS. The effects of below-elbow immobilization on driving performance. Injury 2017;48(02):327–331.

9.     Argintar E, Williams A, Kaplan J, et al. Recommendations for driving after right knee arthroscopy. Orthopedics 2013;36(05):659–665.

10.  Wasserman BR, Singh BC, Kaplan DJ, et al. Braking reaction time after right-knee anterior cruciate ligament reconstruction: a comparison of 3 grafts. Arthroscopy 2017;33(01):173–180.

11.  Egol KA, Sheikhazadeh A, Mogatederi S, Barnett A, Koval KJ. Lower-extremity function for driving an automobile after operative treatment of ankle fracture. J Bone Joint Surg Am 2003;85-A(07):1185–1189.

12.  Egol KA, Sheikhazadeh A, Koval KJ. Braking function after complex lower extremity trauma. J Trauma 2008;65(06):1435–1438.

13.  Driver Fitness Medical Guidelines. Washington, DC: National Highway Traffic Safety Administration; 2009. Available at: https://www.nhtsa.gov/sites/nhtsa.gov/files/811210.pdf

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