Riders after surgery: hip precautions, spine precautions, casts, and face-down positioning

Start with the discharge instructions

Post-surgical precautions are set rider by rider, so the driver works from the written instructions, not from a general rule. The American Academy of Orthopaedic Surgeons says hip precautions vary with the surgical approach and that not all surgeons recommend the same ones. Spine surgery is less settled still: a 2025 systematic review in the Journal of Spine Surgery found activity limits such as no bending or twisting are commonly prescribed, but the evidence behind them is low certainty and no studies covered limits after neck or thoracic spine surgery.

What dispatch needs before the trip:

• The surgery and the side. “Left hip, posterior approach” tells the driver which leg to protect.
• The written precautions. Ask the discharge planner or family to read them out, or send them.
• The equipment. Walker, crutches, brace, cushion, knee immobilizer, or a leg that has to stay raised.
• The head position, for anyone coming from eye surgery.
• Who rides along. Riders leaving the same day after sedation have their own rules about a responsible adult, covered in our guide to rides home after outpatient surgery.

Hip replacement: the 90-degree rule meets a car seat

Most hip precautions exist to keep the new joint from dislocating, and the American Academy of Orthopaedic Surgeons says that risk is highest in the first few months. Its list of common precautions reads like a description of getting into a low car:

• Do not cross the legs at the knees for at least six to eight weeks.
• Do not bring the knee on the operated side higher than the hip.
• Do not lean forward while sitting or while sitting down.
• Do not bend at the waist beyond 90 degrees.
• Keep the operated leg facing forward and in front when sitting or standing.

A low sedan seat or a deep bucket seat puts the knees above the hips the moment the rider sits. The Academy suggests firm pillows for chairs, sofas, and the car so patients sit with their knees lower than their hips, and a high chair for patients with posterior precautions. For the ride, that means:

1. Pick the seat before you arrive. A firm, level seat at a reasonable height beats a low one. Slide it back for legroom.
2. Add a firm cushion if the seat is low. The aim is knees lower than hips.
3. Let the rider lead the transfer. Riders usually leave with their own instructions from the surgeon and therapist. Steady the walker and the door, and do not lift or swing the operated leg unless the rider asks.
4. Buckle the belt for them. Reaching down beside the hip for the buckle is the kind of forward bend the precautions forbid. The same goes for picking up anything dropped on the floor.

Getting into a high van brings the opposite problem: a tall step. The Academy calls stairs a particular hazard after knee replacement until the knee is strong and mobile, and the first item on its hip list is simply not to fall. Use a step stool with handholds or the lift, as our guide to preventing rider falls describes.

Knee replacement and a leg that has to stay straight

A new knee may not bend far enough for an ordinary seat. The Academy ties a return to driving, about four to six weeks after a knee replacement for most people, partly to the knee bending enough to get into the car and sit comfortably. Until then, a rider may need the seat slid all the way back or a wheelchair with a legrest that raises.

Casts and splints add a second rule: elevation. The Academy tells patients to keep an injured arm or leg above the heart for the first 24 to 72 hours, using pillows or other support, and notes that a patient must recline to do that with a leg cast. A rider who must keep a leg up cannot sit upright for a 40-minute ride. That points to a reclining wheelchair or a stretcher, decided at booking.

Two cast facts change the pickup:

• Fresh walking casts are soft. The Academy says not to walk on a walking cast until it is completely dry and hard, about an hour for fiberglass and two to three days for plaster.
• Swelling builds under a cast. Swelling can cause pressure inside a cast for the first 48 to 72 hours, and the Academy lists the signs that need a call to the doctor’s office right away. They are covered further down.

Spine surgery: plan the turn so the rider does not twist

After a spinal fusion, the Academy says the spine must be kept in proper alignment while the bone heals, which can take several months, and patients are taught how to move, sit, stand, and walk. The surgeon may add a brace. Physical therapy usually starts six weeks to three months after surgery, so these riders may turn into regular therapy trips later on.

For the driver, the job is giving the rider room to use the method they were taught:

• Make space. Slide the seat back and recline it a little if the rider asks, so they can sit and bring the legs in together without twisting.
• Do not pull on the arms or trunk. Steady, do not steer. A gait belt may not suit a rider recovering from back or abdominal surgery, as the gait belt entry explains.
• Leave the brace as the rider has it. Adjusting it is for the rider or caregiver, following the surgeon’s instructions.

Arm slings are simpler but still change the trip. A rider in a sling cannot push up from the seat or pull the door with that arm, so ask which side is in the sling, seat them so the free hand can hold a grab handle, and fasten the belt for them.

Face-down after retina surgery

Some eye operations end with a gas bubble inside the eye, and the bubble only works if the head stays in a set position. The American Academy of Ophthalmology says that after macular hole surgery the patient must keep the face down, or in another set position, at all times for up to a week and sometimes longer. After retinal detachment surgery it gives one to two weeks as an example. The surgeon chooses the position, and patients wear an eye patch after surgery.

That position has to survive the ride. Ask the surgeon’s office what the rider must do during the trip and for how long, and book the level of service that allows it. A rider who must stay face down may need a stretcher: Washington’s Medicaid rules, as one example, define a stretcher trip as one where the client must travel prone or supine for medical or safety reasons.

Altitude is the second rule. The Academy says a patient with an air or gas bubble cannot fly, go up into the mountains, or travel to high altitudes until the bubble is gone, because the change in altitude makes the gas expand and raises eye pressure. The National Eye Institute gives the same warning about flying and adds that the patient should not be given nitrous oxide for any procedure until the bubble has cleared. For a NEMT company, that means:

• Check the route on long trips. A ride to a specialist that crosses a mountain pass needs the surgeon’s approval first.
• Flag dental trips. A rider with a gas bubble going to the dentist should tell the dentist before any treatment.
• Guide the rider. With the operated eye patched or blurred by the bubble, the rider is seeing with one eye, so curbs and the van step are harder to judge.

Reclining seat, wheelchair van, or stretcher

The right vehicle follows from what the rider has to avoid. Work through it at booking:

1. Can the rider sit with the knees below the hips and not lean forward? A car or van seat with a cushion may be enough for a hip.
2. Must a leg stay straight or raised? Think about a wheelchair with a raised legrest or a reclining seat, and a stretcher if neither works for the length of the ride.
3. Must the rider lie flat or face down? That is a stretcher trip, and programs such as Washington’s require a medical or safety reason for it.
4. Can the rider bear weight for a transfer today? If not, the trip needs more help than a driver alone can give. See what NEMT drivers can and cannot do.

For riders leaving a hospital, our hospital discharge guide covers who books and pays for the ride.

Warning signs on the way home

The first weeks after surgery carry risks a driver should recognize, even though treating them is not the driver’s job. The Academy’s knee replacement and cast care pages list these:

• Possible blood clot in the leg. Increasing calf pain, tenderness or redness above or below the knee, and new or growing swelling in the calf, ankle, or foot.
• Possible clot in the lung. Sudden shortness of breath, sudden chest pain, or chest pain felt in one spot when coughing. Treat this as an emergency; the driver’s part is set out in when a rider has a medical emergency in the van.
• Trouble under a cast. Increasing pain and a cast that feels too tight, numbness or tingling, burning or stinging, heavy swelling below the cast, or toes or fingers the rider cannot move. The Academy says the last of these needs urgent evaluation.

When a rider mentions any of these, tell dispatch and the person receiving the rider, and note it on the trip.

Getting the vehicle right

Wheelchair, stretcher, and oxygen needs are matched in HealthRide, so a rider booked lying down goes on a vehicle that carries a stretcher. The weeks of therapy that follow a joint replacement or fusion can be booked as recurring trips. Schedule it once. HealthRide keeps it going.