Driving After Surgery

Driving After Knee Surgery:  

There are no well established guidelines that I am aware for determining when it is safe to drive after injury or treatment. For lower limb surgery what we are really interested in is the effectiveness of and time taken to perform an emergency stop.

It is fairly obvious that patients should not drive with a cast or brace on the right leg or if they are still experiencing pain when weight bearing on the limb.

If they are driving an automatic car then surgery to the left lower limb is usually not an issue.   If all goes well then most patients will be able to brake effectively 4 weeks after a knee arthroscopy and 4-6 weeks after a total knee replacement but this is very patient specific and can vary greatly.

It may be as much as 9 weeks for an ankle fracture and a minimum of 6 weeks from when they start to weight bear for a lower limb fracture.   In general the definition of what constitutes an impaired driver is decided on a case by case basis and the ultimate responsibility for the decision to drive rests with the patient.

There is some concern that by clearing the patient to drive Doctors are exposing themselves to liability for injuries incurred by or caused by the patient.   Some patients will tell you that they can use their left foot to brake but this has been shown to have a slower ‘reaction’ time than standard one footed braking and cannot be recommended as a safe option.  

The last issue is whether braking hard will damage the surgical repair performed. This is unlikely to be the case in a knee replacement or arthroscopy but could be the case in an ACL reconstruction.    There is a correlation between braking ability and the ‘step test’ and ‘stand test’ and these can be helpful but should not be used in isolation when deciding fitness to drive.  (Hau, R, Csongvay S, Bartlett J: Driving Reaction time after right knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 2000;8(2):89-92) 

Driving is an important function for patients. It is obvious that a patient should not attempt to drive when it is not safe to do so but knowing when they are safe is very difficult. The times noted above are guidelines at best and decision making should be individualized to each patient. On the whole it is better to wait longer if you or the patient do not feel confident about their emergency braking ability.  

Driving After an Upper Limb Injury or Surgery:  

The use of both arms is essential to safely operate an unmodified vehicle. It has been shown that anyone wearing an upper extremity cast would fail a driving test. This applies to above elbow and below elbow casts and is worse when the thumb is included in the cast.

Drivers in casts tend to have worse responses to hazards in a driving simulator and also drive more cautiously. Drivers wearing a sling were involved in significantly more crashes than those using both arms. Even healthy volunteers wearing a sling had impaired driving ability.   It is my recommendation that any patient wearing any form of upper limb splint or sling not operate a motor vehicle.

To view further information on driving guidelines please click on this link: Driving after Surgery Guidelines 2014
Dr Doron Sher

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