Abstract
INTRODUCTION
The primary goal of THA or TKA is to relieve pain and restore mobility. The success is determined by the longevity of prostheses and early return to routine activities, such as driving. With enhanced recovery regimens, patients are being discharged within 24–48hrs post-op.. The aim of this study was to determine when our patients returned to driving after anterior hip replacements and patient specific knee replacements.
METHODOLOGY
This study included 207 soft tissue sparing anterior bikini THA and 146 patient specific instrumented (PSI) TKAs between Feb 2017 and March 2018. All patients included drove before surgery. Non-drivers were excluded. A detailed questionnaire was sent to all patients 3 to 6 weeks after surgery to record their driving status. 50 patients were randomly selected to assess flexion at the hip, knee, and ankle joints whilst seated in the driver's seat of their vehicle.
RESULTS
There were 213 females and 124 males (mean age of 69 years) and average BMI of 18.24. There were 207 THAs (99 left, 106 right and 1 bilateral one stage) and 146 TKAs (L=70 & R=76). 76% of patients returned to driving within the first 3 weeks after surgery of which 32 patients (21 THAs (14%) and 11 TKAs (10%)) resumed driving within the first post-op week, 110 patients (69 THAs (39%)and 49 TKAs (35%)) drove in the second week and 73 (38 THAs (23%)and 38 TKAs(28%)) returned to driving in the third week. The rest of the 82 patients reports that they could have driven earlier but chose not to, since they had alternatives that they preferred. The earliest a patient resumed driving post-surgery was on the 2nd day(Post THA and TKA). 96.4% stated that they were confident when they first resumed driving. There were 40 patients out of the total 337 that did not return to driving post-surgery. 3 (2 hips and 1 knee) due to medical comorbidities and the rest 37 (14 THAs and 6TKAs) reported they had their children/spouses to drive them but were confident that they could have driven themselves if required.
There was statistically no direct correlation between resumption of driving and the side of surgery. There were 282 patients driving automatic cars, 23 driving manual cars and the remaining did not comment. Out of the manual car drivers, 8 were operated on the left side (5 hips and 3 knees), but still all confidently returned to driving within 6 weeks earliest returning within the 1st week. Post measurement of angles of flexion at hip, knee and ankle while accelerating and braking among 50 patients we found that ankle movements significantly affect driving more so than hip and knee.
CONCLUSION
We found that after soft tissue sparing anterior bikini THA and PSI TKA, patients were driving as early as within a week with the majority feeling confident and less apprehensive about recommencing driving, potentially due to enhanced recovery measures which were taken, including the minimally invasive surgical technique, local analgesia infiltration and early mobilization post procedure.
