Factors that Affect the Return-to-Driving Timeline Following Direct Anterior Approach Primary Total Hip Arthroplasty

When patients can return to driving (RTD) following direct anterior approach (DAA) primary total hip arthroplasty (pTHA) is a common concern. Current prospective literature is limited and does not consider individual patient factors. Here, we aimed to determine an accurate RTD timeline and develop a clinical calculator using patient-specific variables.

In this study, 182 patients undergoing DAA pTHA were prospectively enrolled. Subjects received daily text message surveys postoperatively to determine when they RTD. In addition, subjects completed a preoperative interview and RTD survey. Data on patient factors (demographics, patient-reported outcomes, and so on) were collected. Cox proportional hazard and parametric survival models were utilized to create a novel preoperative clinical calculator for predicting RTD time with patient-specific variables. There were 164 patients who completed the study, with a mean age of 65 years (range, 39 to 85) and 51.2% (n = 84) being women.

The median RTD time was 15 days (interquartile range, 10.5 to 19), with 80.5% (n = 132) returning within 21 days. Factors associated with quicker RTD time included men (4.4 days sooner; P < 0.01), left-sided surgery (3.2 days sooner; P < 0.01), and driving a truck (4.8 to 5.9 days sooner; P < 0.05). Variables with the largest possible effect on RTD time were preoperative Patient-Reported Outcomes Measurement Information System Physical Health score (12.1 days), preoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (11.3 days), body mass index (9.0 days), type of primary vehicle (6.3 days), laterality (5.4 days), and age (5.0 days). A novel clinical calculator was created using patient-specific variables to preoperatively predict a patient's RTD time.

Patients undergoing DAA pTHA returned to driving earlier than published prospective trials. Various patient-specific factors affected the RTD timeline and were included in a novel clinical calculator. The nonvalidated calculator can be utilized to preoperatively counsel patients on their expected RTD timeline after DAA pTHA.