"When can I drive again?" is one of the first questions people ask after surgery. The answer depends on what type of surgery you've had, which limb is affected, and how your recovery is going.

This article covers the general rules in NSW, common surgical scenarios, and when an OT driving assessment may come into the picture.

The general rules

There are a few baseline rules that apply to everyone after any surgery in NSW.

After a general anaesthetic or sedation, you must not drive for at least 24 hours. Your doctor will usually advise you of this before discharge. During this period, your reaction time, coordination, and judgement are all impaired, even if you feel fine.

While taking strong pain medication (particularly opioid-based medications), you should not drive. These medications can significantly affect your alertness, reaction time, and concentration. Your doctor or pharmacist should advise you about this.

You must be able to safely control your vehicle. This is the overarching principle. Regardless of the specific surgery, you need to be able to operate the steering wheel, accelerator, brake, and other controls safely, and be able to perform an emergency stop if required. If you can't do this, you're not fit to drive.

Your insurance may not cover you. If you drive against medical advice or while impaired by medication, your car insurance may be invalid. If you have an accident in these circumstances, you could be personally liable.

Driving with a cast, brace, or sling

Transport for NSW has specific guidance on this.

A cast on your leg or foot can prevent you from safely using the pedals. If you have a cast on your right leg (or either leg if you drive a manual), you generally should not drive until the cast is removed and your strength and mobility have returned.

A cast on your arm or hand may still allow you to drive, but only if you can operate all vehicle controls and keep a hand on the steering wheel at all times. If you drive a manual vehicle, you'll also need to be able to change gears. A cast will likely may make this difficult.

A shoulder sling or arm immobiliser generally prevents safe driving, as you can't use both arms to steer.

In all of these situations, talk to your doctor before driving. The fact that you physically can drive doesn't mean you should, particularly if pain, stiffness, or reduced strength could affect your ability to respond in an emergency.

Common surgical scenarios

Hip replacement

Most people can return to driving approximately 6 weeks after a hip replacement, though this varies. Key factors include the type of hip operation, your pain levels, and whether you've regained enough strength and range of motion to operate the pedals and get in and out of the car safely.

Your surgeon should advise you on when it's safe to resume driving based on your individual recovery.

Knee replacement

Similar to hip replacement, most people return to driving approximately 6 weeks after a knee replacement. Right knee surgery typically requires a longer wait than left knee surgery (for automatic vehicle drivers), because the right leg controls the accelerator and brake.

You should be off strong pain medication and able to perform an emergency stop safely and with minimal pain before returning to driving.

Foot and ankle surgery

If your right foot or ankle was operated on, you generally can't drive until the cast or boot is removed and you've regained normal strength and pedal control. This is often 6 weeks or more after surgery.

Eye surgery

After eye surgery, you must not drive until your vision has returned to the standard required for driving. Your ophthalmologist will advise on this. If you've had pupil-dilating drops during an examination (not surgery), you should avoid driving until the effects wear off, usually a few hours.

Brain or spinal surgery

Surgery involving the brain or spinal cord may have lasting effects on your driving ability and may require a formal fitness-to-drive assessment process. Your neurosurgeon or rehabilitation specialist will guide this.

When an OT driving assessment is needed after surgery

Most people who have surgery (hip replacements, knee replacements, shoulder surgery, etc.) don't need a formal OT driving assessment to get back to driving. Their surgeon clears them once they've recovered enough, and that's the end of it, they're back driving.

An OT driving assessment is more likely to be needed when:

• The surgery has caused lasting changes to your function. For example, if a brain tumour was removed and there are ongoing cognitive effects, or if a spinal surgery has resulted in permanent weakness or altered sensation.

• You need vehicle modifications. If your surgery has resulted in a permanent change that requires adaptive equipment (such as hand controls due to loss of leg function), an OT will need to assess you, prescribe the modifications, and arrange a reassessment and (if required) a disability driving test through Transport for NSW.

• You had a pre-existing medical condition that affects driving, and the surgery has changed the picture. For example, if you already had a neurological condition and surgery has either improved or worsened your function.

• Your doctor isn't sure whether you're safe to drive. If recovery has been slower than expected, or there are concerns about cognitive or physical function, your doctor may refer you for an OT driving assessment to get a clear answer.

How to know when you're ready

As a general guide, you're probably ready to return to driving when:

You're no longer taking strong pain medication that could impair your alertness or reaction time. You can walk comfortably without crutches or a walking frame. You can get in and out of the car without difficulty. You have enough strength and range of motion to operate all vehicle controls comfortably. You could perform an emergency stop if needed. Your surgeon has given you clearance to drive.

If you're unsure, ask your surgeon directly. It's a reasonable question, and they should be able to give you a clear answer based on your recovery.

Getting help

If you've had surgery and your doctor has concerns about your fitness to drive, they can refer you for an OT driving assessment. You can start the process at steerdriving.com.au/referral.

For most post-surgical driving questions, your surgeon or GP is the right person to ask. An OT assessment is only needed when the situation is more complex.

Need an OT driving assessment in Sydney? Steer Driving is a mobile OT driving assessment service covering greater Sydney. If you have a referral from your GP or specialist, you can start the process here - Start a Referral.

This article was written by Elise, an AHPRA-registered Occupational Therapist and Transport for NSW-registered driver assessor. Elise is the founder of Steer Driving, a mobile OT driving assessment practice in Sydney.

FAQ Section

How long after surgery can I drive? It depends on the type of surgery. After a general anaesthetic, you must wait at least 24 hours. For joint replacements, it's typically at least 6 weeks. For other surgeries, ask your surgeon for specific advice based on your recovery.

Can I drive with a cast on my leg in NSW? Generally not. A leg cast can prevent you from safely operating the pedals. You should wait until the cast is removed and your strength and mobility have returned. Talk to your doctor.

Can I drive with my arm in a sling? Generally not. You need to be able to use both arms to safely control the steering wheel. Wait until you've been cleared by your surgeon.

Do I need to notify Transport for NSW after surgery? Only if the surgery has resulted in a lasting medical condition that may affect your driving. Temporary conditions (like a broken leg that will heal fully) generally don't need to be reported, but check with your doctor.

Does my insurance cover me if I drive after surgery? If you drive against medical advice or while impaired by medication, your insurance may be invalid. Check with your insurer and follow your surgeon's advice about when it's safe to resume driving.

When do I need an OT driving assessment after surgery? Most post-surgical situations don't require one. An OT assessment is needed when surgery has caused lasting functional changes, when vehicle modifications are required, or when your doctor is unsure whether you're safe to drive.