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Tomasz Poboży

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Stairs After Surgery — How to Go Up and Down Safely

Autor:

Tomasz Poboży

After many lower-limb operations, stairs can be used, but the technique depends first of all on how much weight is allowed through the operated leg. Early on, patients usually use a step-to pattern while holding a handrail and a crutch. The safest approach is to practise the technique with a physiotherapist or ward staff before attempting stairs independently.

First check the weight-bearing instructions from your orthopaedic surgeon

“After surgery” covers very different situations. After some procedures, weight bearing as tolerated is permitted from the beginning. After others, only partial weight bearing is allowed, and sometimes the limb must remain non-weight-bearing for a period. The instruction depends on the operation, bone quality, stability of fixation and tissue healing.

The key information in the discharge plan is therefore not simply how many days have passed since surgery, but the exact weight-bearing instruction. If this is unclear, do not guess and do not use pain alone as a guide. Little pain does not automatically mean the repaired or fixed structure is ready for full loading.

How to go upstairs with a handrail and one crutch

For a typical unilateral lower-limb operation, once this method has been approved:

  1. Stand close to the first step. Hold a secure handrail with one hand and the crutch with the other.
  2. Place the non-operated leg on the higher step.
  3. Bring the operated leg up to the same step.
  4. Bring the crutch up last.

A simple way to remember the sequence is: the stronger leg leads going up. Take one step at a time initially rather than trying to use a normal alternating pattern straight away.

How to go downstairs

  1. Stand close to the edge of the step and hold the handrail securely.
  2. Place the crutch on the lower step.
  3. Lower the operated leg.
  4. Bring the non-operated leg down last.

The order is therefore reversed when descending: the support and operated leg go first, the stronger leg follows. Avoid leaning far forward and never place the crutch tip on the edge of the step.

Two crutches, one crutch or a walker?

Where a handrail is available, two crutches can sometimes be held together in one hand after proper instruction while the other hand uses the rail. Without a handrail, stair negotiation with two crutches is more difficult and requires good balance. Initial attempts should be supervised.

A walking frame or walker provides useful stability on level ground, but it is not designed for climbing a full flight of stairs. If a walker is the only safe mobility aid, an alternative route, assistance from another person or temporary living on one level should be planned.

When can alternating stair climbing return?

There is no single universal date. In general, the following are needed:

  • permission for sufficient loading of the operated limb;
  • adequate pain control without dizziness or excessive medication-related drowsiness;
  • enough hip, knee and ankle range of motion;
  • sufficient strength to lift the body onto the step and control the descent;
  • no obvious knee buckling, loss of balance or progressively worsening limp.

Alternating steps often return sooner when going up than when going down. Descent requires good eccentric muscle control — the ability to slow the body under load.

Preparing stairs at home

  • Remove loose rugs, cables and objects from the stairs.
  • Ensure good lighting, including for night-time trips to the bathroom.
  • Check that the handrail is secure and easy to grip.
  • Wear closed, non-slip footwear. Avoid loose slippers and walking in socks.
  • Do not carry objects in your hands while using crutches. Small items can be carried in a light backpack.
  • If the stairs are winding, steep or lack a rail, arrange supervision and reduce the number of trips where possible.

When should you stop?

Stop the attempt if you lose balance, the leg suddenly gives way, pain rises sharply, or you develop dizziness or marked drowsiness. A fall, sudden pain with deformity, a snap followed by loss of function or a new inability to bear weight requires prompt assessment.

Urgent review is also needed for increasing numbness, a cold or pale foot, rapidly worsening swelling, wound drainage, fever, a hot and markedly red operative area, or new calf pain and swelling — particularly if accompanied by shortness of breath.

The most important rule

The familiar rule “stronger leg up, operated leg down” is a useful memory aid, but it does not replace the instructions for a specific operation. Recovery after joint replacement, ligament reconstruction, fracture fixation or bilateral surgery may require different precautions.

Sources

Polish version · More on recovery after orthopaedic surgery

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

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