From the Research
Orthopedic guidelines generally recommend waiting 1-2 weeks after an uncomplicated total knee replacement before flying, with the most recent and highest quality study 1 suggesting that the risk of venous thromboembolism is low, but still present. For short flights (under 2 hours), some patients may fly as early as 7 days post-surgery if recovery is progressing well, as indicated by the study 1 which found no clear difference in the risk of pulmonary embolism or symptomatic deep vein thrombosis with the use of low-molecular-weight heparin (LMWH) or rivaroxaban. For longer flights, waiting 10-14 days is preferable to reduce risks, as the study 2 found that LMWH may have a higher risk of venous thromboembolism compared to factor Xa inhibitors in patients undergoing total knee replacement. When flying, patients should:
- Request an aisle seat for easier movement
- Perform ankle pumps every 30 minutes
- Stand and walk briefly when safe
- Stay hydrated
- Wear compression stockings to prevent blood clots Taking prescribed blood thinners like enoxaparin (Lovenox), rivaroxaban (Xarelto), or aspirin is crucial before flying, as the study 3 found that LMWH was superior to intermittent pneumatic compression of the foot for thromboprophylaxis after total knee replacement. The main concerns with early air travel include:
- Deep vein thrombosis risk
- Limited mobility in confined spaces
- Potential swelling due to cabin pressure changes
- Discomfort during prolonged sitting Patients should consult their surgeon before booking flights, as individual recovery varies and some may need to wait longer based on their specific surgical outcome, overall health, and risk factors, as suggested by the study 4 which found that the incidence of deep vein thrombosis was low, but still present, in patients undergoing knee arthroscopy. It is also important to note that the study 5 found that combined mechanical and pharmacological prophylaxis can significantly reduce the incidence of deep vein thrombosis after total knee replacement. Overall, the most recent and highest quality study 1 provides the best evidence for guiding orthopedic guidelines for flying after total knee replacement, and patients should follow the recommendations outlined above to minimize their risk of complications.