Knee Replacement: Safe Techniques for Getting Up from a Chair

How do you get up from a chair after knee replacement?

Safely getting up from a chair after knee replacement surgery requires a deliberate, controlled technique that prioritizes stability, minimizes strain on the new joint, and leverages core and upper body strength while adhering to your surgeon's specific post-operative guidelines.

Understanding Post-Knee Replacement Mobility

Following total knee arthroplasty (TKA), the goal is to restore mobility while protecting the surgical site. The immediate post-operative period is crucial for managing pain, controlling swelling, and initiating controlled movement. The ability to transition from sitting to standing is a fundamental functional movement, but it must be performed with specific biomechanical considerations to avoid complications like falls, excessive pain, or undue stress on the prosthetic joint. Your physical therapist will be your primary guide in mastering this and other essential movements.

Key Principles for Safe Standing

Before attempting to stand, understand the underlying principles that govern safe and efficient movement after knee replacement:

• Pain Management is Crucial: Ensure your pain is adequately managed before attempting transfers. Acute pain can lead to compensatory movements that are unsafe.
• Weight-Bearing Restrictions (If Any): While most modern knee replacements allow immediate full weight-bearing, always confirm your surgeon's specific instructions. If partial weight-bearing is advised, your physical therapist will teach you how to modify the technique.
• Proper Foot Placement: The base of support is critical. Feet should be positioned to provide stability and leverage.
• Utilize Armrests: Armrests are essential for providing upper body support and reducing the load on your lower extremities.
• Engage Core and Thighs: Activating your core muscles helps stabilize the trunk, and engaging your quadriceps and glutes provides the power for the upward movement.
• Maintain Spinal Alignment: Avoid excessive rounding or arching of the back. A slightly forward lean from the hips is appropriate, but maintain a neutral spine.

Step-by-Step Guide: Getting Up Safely

This technique is designed to be performed from a sturdy chair with armrests. Avoid recliners or low, soft couches in the early stages of recovery.

1. Prepare Your Environment:

   • Ensure the chair is stable and will not slide.
   • Remove any obstacles from your path.
   • Have your walker, crutches, or cane positioned within easy reach, typically directly in front of you.

2. Position Yourself at the Edge:

   • Scoot forward in the chair until you are sitting on the front edge, with your buttocks slightly off the backrest. This allows for a more advantageous angle to initiate the stand.

3. Foot Placement:

   • Operated Leg: Position your operated leg slightly forward of your non-operated leg, with the heel closer to the chair. This reduces the acute angle of knee flexion and minimizes stress on the new joint during the initial push-off.
   • Non-Operated Leg: Plant your non-operated foot firmly on the floor, directly under your knee, ready to bear the majority of your initial weight.

4. Hand Placement:

   • Place both hands firmly on the armrests of the chair. Do NOT push off your operated knee or any furniture that is not stable.

5. Lean Forward and Engage:

   • Lean your torso forward from your hips, positioning your nose over your toes. This shifts your center of gravity forward, making it easier to stand.
   • Engage your abdominal muscles (core) to stabilize your trunk.

6. Push Through Heels:

   • Push down firmly through your hands on the armrests, simultaneously pushing through the heels of both feet, but primarily through your non-operated leg.
   • Think about driving your hips up and forward, rather than just pushing straight up.

7. Stand Tall:

   • As you rise, use the strength of your glutes and quadriceps, particularly on your non-operated side, to complete the stand.
   • Once upright, pause briefly to ensure you are stable before reaching for your assistive device.

8. Pause and Stabilize:

   • Once standing, pause for a moment to regain your balance and ensure you are not dizzy. Only then should you reach for your walker or crutches.

Common Challenges and Troubleshooting

• Excessive Pain: If you experience sharp or increasing pain, stop the movement. Re-evaluate your technique, ensure pain medication is effective, and consult your physical therapist or surgeon if pain persists.
• Weakness or Instability: This is common initially. Rely heavily on your armrests and the strength of your non-operated leg. Practice strengthening exercises as advised by your physical therapist.
• Dizziness: Stand up slowly. If you experience lightheadedness, sit back down immediately. This can be due to pain medication, dehydration, or changes in blood pressure.
• Swelling: While swelling is normal, excessive swelling can make movement uncomfortable. Elevate your leg when resting and apply ice as directed by your medical team.

Progression and Rehabilitation

Your ability to get up from a chair will improve significantly with time and consistent physical therapy.

• Early Stages (Hospital/Immediate Post-Op): Focus on the precise technique described, using armrests and assistive devices for maximum support and safety.
• Intermediate Stages (Home Recovery): As strength and confidence improve, you may gradually reduce reliance on armrests, transitioning to using only one hand or performing the movement with minimal upper body assistance. Your physical therapist will introduce exercises to strengthen the muscles critical for this movement, such as sit-to-stand repetitions, squats, and glute bridges.
• Long-Term Considerations: Eventually, you should be able to stand from a chair without armrest assistance and with minimal conscious effort, integrating it back into your daily routine as a natural movement. Continue with a consistent exercise program to maintain strength and flexibility.

When to Seek Medical Advice

Contact your surgeon or physical therapist immediately if you experience:

• Sudden, severe pain in the operated knee.
• Inability to bear weight on the operated leg (unless specifically instructed).
• Signs of infection (fever, chills, redness, warmth, pus from the incision).
• New or worsening swelling that does not improve with elevation and ice.
• Numbness or tingling in the leg or foot.
• Any unexplained symptoms that cause concern.

Conclusion

Mastering the sit-to-stand transfer after knee replacement is a cornerstone of your recovery. By adhering to the precise technique, utilizing appropriate support, and diligently following your physical therapy regimen, you will progressively regain the strength and confidence necessary for independent mobility. Patience, consistency, and close communication with your healthcare team are paramount to a successful rehabilitation.