Knee Replacement Recovery: Safely Entering and Exiting the Bathtub

How to get in a bathtub after knee replacement?

Navigating bathtub entry and exit after knee replacement surgery requires careful planning, specific assistive devices, and adherence to precise techniques to ensure safety, protect the healing knee, and prevent falls.

Understanding Post-Surgical Precautions

Before attempting to use a bathtub, it is paramount to understand and adhere to your surgeon's and physical therapist's specific post-operative instructions. These precautions are designed to protect your new knee joint and facilitate optimal healing. Key considerations include:

• Incision Care: Your incision must be completely closed, dry, and cleared by your surgeon for immersion in water. Submerging an unhealed incision can lead to infection. Many surgeons recommend waiting several weeks before full bath immersion, often advising showers first.
• Weight-Bearing Restrictions: You may have partial or full weight-bearing restrictions. Your method of entry and exit must account for these limitations, often relying more heavily on your unoperated leg or assistive devices.
• Range of Motion (ROM) Limitations: Early post-op, deep knee flexion might be restricted or painful. The technique for entering and exiting the tub should minimize excessive bending of the operated knee.
• Fall Risk: Pain, medication, general weakness, and altered balance post-surgery significantly increase the risk of falls, making bathroom safety a top priority.

Essential Equipment and Modifications

Preparing your bathroom environment is crucial for safety and ease of movement. Invest in or arrange for the following:

• Grab Bars: Install sturdy, professionally installed grab bars on the wall adjacent to the tub. Ideally, one vertical bar near the entry point and one horizontal bar along the inside wall of the tub for support while lowering and rising. Suction-cup grab bars are generally not recommended as primary support due to their unreliability.
• Non-Slip Mat: Place a non-slip mat or appliques inside the tub to prevent slipping when wet. A large, non-slip bath mat should also be placed on the floor outside the tub.
• Shower Chair or Bench: A transfer bench that extends over the side of the tub is highly recommended. This allows you to sit down outside the tub and swing your legs over, minimizing standing balance required. A standard shower chair placed inside the tub can also provide a stable seated position for bathing.
• Handheld Showerhead: This allows you to wash while seated, reducing the need to stand or maneuver within the tub.
• Long-Handled Sponge or Brush: To reach areas that may be difficult to access due to limited bending or reach.
• Assistive Devices: Keep your walker, crutches, or cane within easy reach just outside the tub.

Step-by-Step Guide: Getting Into the Bathtub Safely

Always proceed slowly, intentionally, and with a clear mind. If possible, have someone present for assistance, especially during initial attempts.

1. Prepare the Bathroom: Ensure the floor is dry, the non-slip mat is in place, and all necessary equipment (grab bars, shower chair/bench, handheld shower) is ready and within reach.
2. Approach the Tub: Use your walker or crutches to approach the tub. Position yourself parallel to the tub, facing the faucet wall, with the unoperated leg closer to the tub.
3. Position the Shower Transfer Bench (if using): If using a transfer bench, ensure one end is outside the tub and the other end is securely inside. Back up to the bench until the back of your unoperated knee touches it.
4. Sit Down: Carefully lower yourself onto the transfer bench, or onto the edge of the tub if not using a bench (this is more challenging). Use your hands to push off your assistive device or a sturdy surface for support. Keep your operated leg extended forward.
5. Swing Legs Over (Transfer Bench Method):
   • Once seated on the bench with both feet on the floor outside the tub, lift your unoperated leg first and swing it over the edge of the tub, placing your foot inside.
   • Next, carefully lift your operated leg, keeping the knee as straight as comfortable, and swing it over the edge, placing your foot inside the tub.
   • Slide carefully along the bench until you are fully inside the tub, centered on the bench or lowering yourself to a shower chair inside the tub. Use grab bars for stability.
6. Swing Legs Over (No Transfer Bench, More Challenging):
   • If you are sitting on the edge of the tub (without a bench), carefully lift your operated leg first, keeping the knee extended, and swing it over the tub edge, placing your foot inside. This requires more core strength and balance.
   • Then, bring your unoperated leg over.
   • Once both legs are in, carefully lower yourself into a seated position on the tub floor or a shower chair, using grab bars for support. Avoid twisting your body.

Step-by-Step Guide: Getting Out of the Bathtub Safely

Exiting the tub is often more challenging than entering due to the need to push up against gravity.

1. Position Yourself: If seated on the tub floor, carefully maneuver yourself towards the transfer bench or the edge of the tub.
2. Prepare to Stand/Transfer: Position your feet flat on the tub floor or on the bench. Use grab bars for support.
3. Swing Legs Out (Transfer Bench Method):
   • Lift your operated leg first, keeping it as straight as comfortable, and carefully swing it over the edge of the tub, placing your foot on the floor outside the tub.
   • Next, lift your unoperated leg and swing it over, placing your foot on the floor outside the tub.
   • Once both feet are on the floor outside, slide carefully along the bench until you are fully positioned off the tub.
4. Stand Up (No Transfer Bench, More Challenging):
   • From a seated position inside the tub, bring your operated leg out first, keeping the knee extended. Place the foot on the floor outside the tub.
   • Then, bring your unoperated leg out.
   • Place both hands firmly on the grab bars. Push up slowly, using the strength of your arms and your unoperated leg, to a standing position. Maintain balance.
   • Once standing, reach for your walker or crutches.

Important Safety Considerations and Tips

• Consult Your Healthcare Team: Never attempt bathing or showering without explicit clearance and specific instructions from your surgeon or physical therapist. They will guide you based on your individual recovery progress.
• Patience is Key: Do not rush. Take your time with each movement. Rushing increases the risk of falls.
• Listen to Your Body: If you experience pain, dizziness, or feel unstable, stop immediately. Rest and reassess.
• Avoid Twisting: Do not twist your body or pivot on your operated leg. Keep your hips, knees, and feet aligned.
• Maintain Dryness: Ensure the bathroom floor is dry before and after use. Water on the floor is a significant slip hazard.
• Consider Showers First: Many individuals find a walk-in shower with a shower chair much safer and easier to manage in the initial weeks post-surgery compared to a bathtub.
• Have Assistance: For the first few times, or if you feel unsteady, have a family member or caregiver nearby to assist you.

When to Consult Your Surgeon or Therapist

Contact your healthcare provider immediately if you experience any of the following:

• Increased pain or swelling in your operated knee.
• Redness, discharge, or warmth around the incision site.
• Fever.
• Sudden loss of balance or a near-fall incident.
• Inability to safely perform the bathing transfer.

Reclaiming independence in daily activities like bathing is a significant step in your knee replacement recovery. By prioritizing safety, utilizing appropriate equipment, and following precise techniques, you can confidently and safely manage getting in and out of the bathtub.