How soon can you fly after hip replacement surgery

A question which patients commonly ask is “When can I fly after having a Hip or Knee Replacement?”
Traditional reservations regarding flying after hip replacement surgery are due to the potentials risk associated with prolonged immobilisation (i.e. not being able around easily).  Immobilisation after major surgery may increase the risk of developing a blood clot (DVT) in the deep leg veins. If a clot breaks off a deep vein and travels to the lungs this is known as a pulmonary embolus (or PE) and can be dangerous.

The risk of DVT is not specific to being on an airplane itself and would also apply to immobility during a lengthy car or bus trip, or even prolonged immobility in bed at home.

With modern surgery and approach strategies to reduce immobilisation, travel soon after surgery can usually be undertaken.

We suggest the following:

1. Discuss your intention to travel with your surgeon.  
2. Obtain additional legroom for your journey.
   If you have the means to do so, we would encourage that you fly  “premium economy”, business class or organise an exit row seat that allows you to move around more easily, rather than being cooped up in a standard economy seat.
   We are happy to provide you with a letter to the airline requesting a seat upgrade (airline discretion as to whether they oblige with this).
3. If you do travel in a tight seat be extra vigilant to move about regularly. An aisle row seat would be preferable so that you can allow get up out of your seat regularly.
4. Move around the cabin frequently. Get out of your seat regularly and go for a walk up up and down the aisle.
   If necessary, take pain relief medications during your travel so that you are comfortable to move around.  Patients are usually very comfortable after minimally invasive surgery (eg Direct Anterior Approach for total hip replacement) and are usually are able to move around more easily.
5. When in your seat perform calf exercises (move your toes up and down) regularly.
6. Drink plenty of water to facilitate good hydration and circulation. The environment and airconditioning inside an aircraft can worsen dehydration.
7. Avoid diuretics (liquids that make you urinate) such as alcohol and coffee as these can contribute you becoming dehydrated.
8. Where possible, limit your travel to relatively short flights.  If you need to travel further, we suggest you favour itineraries which have additional layovers so that you can get off the plane to walk around and stretch your legs.
9. See a surgeon who will perform your surgery with a minimally invasive technique (e.g  an anterior approach hip replacement) and who pays utilises modern pain management techniques.  Patients who are uncomfortable are less likely to be able to move freely and easily around the cabin compared to others who are pain free and not encumbered by restrictions on their range of movement.
10. If you are flying soon after surgery you likely will already be on blood thinner medication to reduce the risk of you developing a clot after surgery.  If you did not receive a script, discuss this with your doctor.

There is no specific legal or medical period during which you cannot fly after surgery.
We, do, however suggest a common sense approach so that you do not incur unnecessary risk – both in terms of the risk of getting a blood clot but also with regard to being far away from your treating hospital if you incurred any other unrelated early surgical complication (such as a wound problem).

When Mr Freedman worked in Paris, patients would routinely fly in/out within days of surgery but these patients were generally taking short European flights. Likewise, a short flight from Melbourne-Sydney is a different situation to flying Melbourne-London.

As general travel advice we suggest:

1. Postpone non-urgent travel until you are walking well with no crutches and are able to get up comfortably to move regularly around the cabin.  (You may raise a few eyebrows if you hobble onto the plane with crutches)
2. Avoid travelling to remote destinations until your surgical wound is healed (usually 7-10 days)
3. Travel with a companion as you may need assistance with managing your luggage
4. Organise/request additional leg room.
5. Exercise and move regularly (see above)
6. Take DVT prophylaxis medication
7. If your flight is longer than 6 hours, wear TED compression stockings during the flight.
8. Travel with comprehensive travel insurance and check that you are compliant with any conditions/restrictions imposed by your insurer and the airline.

For the above reasons we suggest that it would be sensible to avoid non urgent travel for 2 weeks after surgery.
(We commonly schedule a wound check appointment 10-14 days after surgery).

Beyond that, travel capacity will vary depending on a particular patient’s circumstances and recovery but anecdotally, we have many patients who travel comfortably travel short distances (< 3-4 hours) fairly soon after surgery.

For longer journeys (approx > 4 hours), a conservative approach would be to avoid non-essential travel for 4 weeks.

Travel FAQs:

• In most cases NOT, but possibly!

  The implants used in our practice are of the highest quality and the articular bearing is made from European ceramic and NOT metal (as used by many other surgeons). However, there is still metal (titanium or stainless steel) in the stem of the implant that is inserted into the bone.

  Metal detectors at airports are of course designed to detect concealed weapons and so, depending on the sensitivity of the detector used, your implant may potentially set off the detector (if a very sensitive scanner used at that airport).
  If this happens the security officer may rescan your hip region with a hand held scanner or may ask (hopefully politely!) to pat down your pocket area to verify that you are not carrying a weapon. We realise that this is an inconvenience but this is a reality of travel in the 21st century.

  Patients frequently ask if we can provide a letter stating that you have had a hip replacement and we are more than happy to do so, but the airport security may well disregard this (it was so easy to avoid airport screening a “bad guy” would just get a doctor’s letter).

  We also suggest that you do travel with a copy of your X-rays as further evidence that you have had surgery.
  
  Security officers nowadays are well trained to perform quick, courteous and culturally sensitive discreet screening. In all likelihood your implant will NOT set off the metal detector but if it does, thank you in advance for your understanding if they do ask to perform additional security screening.

  You can be assured that the scanners used in airport screening do not pose any risk to the fixation or performance of your prosthesis.

• Can you provide me a letter or travel card to confirm that I've had surgery?

  Yes, we are happy to provide you with a travel card which confirms that you have had a hip or knee replacement. However, airport security may still ask to perform additional screening.

• What blood thinner should I take prior to travel?

  There is no one single correct answer to this as patients' risk of developing a clot is stratified based on their medical history.  For most patients simple Aspirin is sufficient but other patients may require a stronger blood thinner such as Clexane, Warfarin or Xarelto. Your GP or Physician will be able to guide you on this.

Bon voyage! A holiday (and break from work) is an excellent way to assist your recovery after surgery.
Just take things slow and easy and please take lots of photos.  We love seeing our post op patients reclaiming their quality of life after hip replacement surgery. Please send us your travel photos!