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Tomasz Poboży

Kategoria: After Surgery and Return to Function (EN)

English-language patient guidance on recovery after orthopaedic surgery, wound care, mobility, rehabilitation and return to function.

  • Sport After Hip or Knee Replacement — What Can You Do and When?

    Polish version

    After an uncomplicated hip or knee replacement, most patients can gradually return to low-impact activity such as walking, cycling and swimming once the wound has fully healed. There is no single date when every sport becomes safe. Running, jumping, contact sports and activities involving sudden changes of direction require much more cautious assessment because higher loads also increase the consequences of a fall or injury.

    The important question is not only how many weeks have passed since surgery. Healing, muscle strength, balance, range of motion, gait stability, the joint’s response to exercise, the type of replacement and the patient’s previous experience in the sport all matter.

    Do you have to give up sport after joint replacement?

    No. The purpose of joint replacement is to improve function and quality of life, and regular physical activity is an important part of maintaining overall fitness. Current evidence shows that a large proportion of patients return to recreational activity after surgery, particularly low-impact sports.

    In a meta-analysis of knee arthroplasty including 45 studies and 14,498 knees, approximately 85% of patients returned to physical activity or sport, with a median return time of 4.1 months. The authors emphasised, however, that certainty of evidence for the analysed outcomes was very low. These figures describe a population; they are not an individual clearance date for sport.

    A similar pattern is seen after total hip arthroplasty. In a review of 57 studies, the pooled return-to-sport rate was about 85%, with a mean time of approximately 16 weeks. Return to low-intensity activity was much more common than return to high-impact sport.

    Which activities are usually easiest to resume?

    Return is most predictable for activities with lower joint loading and a lower risk of falling. These commonly include:

    • walking and brisk walking;
    • stationary cycling, followed later by outdoor cycling in safe conditions;
    • swimming once the wound is fully healed;
    • water-based exercise;
    • golf;
    • controlled strength training appropriate to the stage of recovery.

    This does not mean that every activity can be restarted immediately. Entering a swimming pool before the wound has fully healed can create wound problems, while cycling in traffic requires substantially more balance and reaction speed than exercising on a stationary bike.

    What about running, tennis, skiing and contact sports?

    The greater the impact, jumping, cutting and risk of falling, the less useful a simple rule such as “you can return after this many weeks” becomes. High-intensity sports are resumed much less often after joint replacement than low-impact activities.

    This is particularly relevant to regular running, contact sports, games with frequent changes of direction, intensive tennis, combat sports and activities with a substantial risk of falling. The issues are not limited to implant wear: dislocation, periprosthetic fracture and an injury requiring another operation also need to be considered.

    This does not amount to an automatic ban on every demanding sport. A patient who has skied recreationally for years and regains full control of the limb after surgery is different from someone planning to start a high-fall-risk sport only after joint replacement. The decision should be individual.

    Is return to sport the same after hip and knee replacement?

    Not entirely. After hip replacement, early limitations may relate to tissue healing, muscle weakness, pelvic control and fall risk. After knee replacement, swelling, limited flexion, stiffness and quadriceps weakness often remain relevant for longer.

    After unicompartmental knee arthroplasty, some patients return to activity more readily than after total knee arthroplasty. In the recent meta-analysis, the probability of returning to physical activity or sport was higher after unicompartmental replacement, but the certainty of this finding was rated very low. It should not be treated as a guarantee of faster return for an individual patient.

    How does an orthopaedic surgeon assess readiness to increase the load?

    Before moving to more demanding activity, function is more useful than the calendar. Favourable conditions for increasing load generally include:

    • a fully healed wound;
    • no increasing pain at rest;
    • stable walking without a pronounced limp;
    • enough range of motion for the planned activity;
    • adequate strength in the operated limb;
    • good balance and movement control;
    • no marked increase in swelling after the current level of exercise.

    If a higher load produces a clear increase in pain or swelling that does not return to the previous level, progression may have been too rapid.

    How should return to sport be progressed in practice?

    A staged return is the safest approach. First rebuild basic function: walking, range of motion, strength and balance. Then increase exercise duration and intensity. More complex sport-specific movements should be introduced later.

    Avoid increasing duration, intensity and technical difficulty all at once. For sports requiring rapid reactions, it is useful to regain movement control first in a safer environment. Patients returning to more demanding disciplines may benefit from physiotherapy assessment and an agreed plan with the operating surgeon.

    When should activity be stopped and medically reviewed?

    New severe pain after a fall, sudden inability to bear weight, obvious deformity, a sensation that the joint has moved out of position or a sudden loss of function requires urgent assessment. Fever, increasing redness, warmth or wound drainage also warrants prompt review.

    New calf pain and swelling may require assessment for deep-vein thrombosis. Shortness of breath, chest pain, coughing up blood or fainting requires immediate medical attention.

    The key principle

    Returning to activity after joint replacement is desirable, but the type of sport should match the stage of healing, current function and the risk of injury. Average time points from studies are useful for planning recovery, but they do not replace assessment of the individual patient.

    In a publication by Tomasz Poboży and Maciej Kielar on selection of hip prostheses, everyday activity and the patient’s future plans were highlighted as relevant elements in treatment planning. That paper does not define the timing of return to sport, but it illustrates why activity level should already be considered when planning surgery and selecting an implant strategy.

    Back to: Before and After Orthopaedic Surgery

    References

    1. Poboży T, Kielar M. The use of various types of hip prostheses depending on the patient’s age and level of everyday activity. Medical Studies/Studia Medyczne. 2015;31(3):213–222. DOI: 10.5114/ms.2015.54763.
    2. Braz R, Gomes E, Valente C, et al. High rate of return to low-impact physical activity or sports after total and unicompartmental knee arthroplasty: A systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2026;34(9):3415–3428. DOI: 10.1002/ksa.70267. PMID: 41527885.
    3. Pasqualini I, Emara AK, Rullan PJ, et al. Return to Sports and Return to Work After Total Hip Arthroplasty: A Systematic Review and Meta-analysis. JBJS Rev. 2023;11(8). DOI: 10.2106/JBJS.RVW.22.00249. PMID: 37549241.
    4. Pasqualini I, Emara AK, Rullan PJ, et al. Return to Sports and Return to Work After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev. 2023;11(7). PMID: 37499045.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • When Can You Stop Using Crutches After Hip or Knee Replacement?

    Polish version

    After an uncomplicated hip or knee replacement, the decision to stop using crutches should not be based on the number of days since surgery alone. What matters most is whether you can walk safely, without a clear limp or giving way of the operated leg, with adequate balance and muscle control. Many patients begin weight-bearing very early, often as tolerated, but progression from two crutches to one and then to unaided walking should reflect the operation performed and the individual postoperative instructions.

    Can you put weight on the operated leg immediately after joint replacement?

    After a typical, stable primary hip or knee replacement, contemporary recovery programmes favour early mobilisation and getting out of bed as soon as practical. ERAS recommendations for hip and knee replacement support early mobilisation, while current physical therapy guidance after total knee arthroplasty emphasises early recovery of walking, balance and efficient movement patterns.

    For uncemented total hip arthroplasty, a meta-analysis of 17 studies found no evidence that immediate unrestricted weight-bearing increased excessive stem micromotion, failure of bone integration or revision risk compared with partial weight-bearing. This does not mean, however, that every patient after every operation may load the leg without restriction.

    When may the instructions be different?

    Temporary weight-bearing restrictions may be needed after revision surgery, an intraoperative or periprosthetic fracture, bone grafting, an osteotomy, repair of additional soft-tissue structures, or whenever the reconstruction needs protection while healing. For that reason, the operating surgeon’s discharge instructions take priority over any general rehabilitation timetable.

    How do patients usually progress from two crutches to one?

    A common sequence is a walking frame or two crutches, followed by one crutch or a walking stick, and finally unaided walking. There is no requirement for every patient to move through each stage at the same time.

    • Two crutches or a walking frame are useful while gait remains uncertain, the leg is weak, pain limits loading or there is a meaningful risk of losing balance.
    • One crutch or a walking stick may be the next step when the patient can safely transfer weight onto the operated leg without clearly increasing the limp.
    • Unaided walking is best introduced when removing support does not worsen gait quality.

    When one crutch or a walking stick is used after hip or knee surgery, it is usually held on the side opposite the operated leg. This reduces the demand on the muscles that stabilise the pelvis and can help maintain a better gait pattern.

    How can you tell when it is reasonable to try walking without crutches?

    Functional criteria are more useful than a fixed date. Reducing support is reasonable when:

    • you can walk on a level surface without a pronounced limp;
    • the operated leg does not feel as though it is giving way or suddenly buckling;
    • your balance allows you to turn, stop and rise from a chair safely;
    • pain and swelling remain controlled after increasing your step count;
    • after knee replacement, quadriceps control is sufficient to keep the knee stable during weight-bearing;
    • after hip replacement, pelvic control is sufficient and walking without a crutch does not produce marked trunk leaning;
    • the orthopaedic surgeon has not prescribed a temporary weight-bearing restriction.

    Is it better to keep one crutch for longer or stop using it as soon as possible?

    If walking without the crutch produces a clear limp, shorter steps, trunk leaning or reluctance to load the operated leg, it is usually more sensible to continue using support for a while and work on strength and gait quality. The goal is not to “get rid of the crutches” as quickly as possible, but to regain safe and reasonably symmetrical walking.

    Conversely, there is no benefit in continuing with two crutches purely out of habit when there are no loading restrictions, walking is stable and the patient can reduce support without deteriorating gait. Current guidance after knee replacement emphasises functional training, balance and gait retraining rather than the passage of time alone.

    What if pain or swelling increases after reducing support?

    A temporary increase in muscle fatigue after greater activity can occur. If changing the way you walk clearly increases pain, swelling or limping, reduce the load and briefly return to the previous level of support. Symptoms that worsen from day to day should prompt assessment of the cause rather than continued attempts to push through them.

    When should you seek urgent assessment rather than wait for a routine review?

    Urgent assessment is particularly important if there is:

    • sudden shortness of breath, chest pain or fainting;
    • markedly increasing one-sided calf swelling with pain or tenderness;
    • fever accompanied by increasing redness, warmth or wound drainage;
    • sudden severe pain after a fall or twisting injury;
    • a new deformity, obvious limb shortening or inability to bear weight after previously making progress;
    • a sudden substantial loss of function instead of gradual improvement.

    Stopping crutches is only one stage of recovery

    Independent walking does not mean rehabilitation is complete. Strength, balance and tolerance of longer periods of activity continue to improve. Readiness for driving, returning to work and returning to sport should be assessed separately rather than inferred simply from the ability to walk without a crutch.

    Back to: Before and After Orthopaedic Surgery

    References

    1. Bove AM, Carroll LA, Cone S, et al. Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026. Physical Therapy. 2026;106(7). DOI: 10.1093/ptj/pzag058.
    2. Huang L, Han W, Qi W, et al. Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis. Front Surg. 2023;10:1225649. DOI: 10.3389/fsurg.2023.1225649.
    3. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Acta Orthop. 2020;91(1):3–19. DOI: 10.1080/17453674.2019.1683790.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Can You Kneel After Total Knee Replacement?

    Polish version

    Yes. Once a total knee replacement has healed properly, kneeling is generally not considered harmful to the implant. For many patients it is still uncomfortable or difficult because of scar tenderness, numb skin, pressure sensitivity, stiffness or fear of putting weight through the operated knee. Kneeling should not be attempted on a fresh or incompletely healed wound, and the timing of return should reflect wound healing and the individual postoperative plan.

    Can kneeling damage a knee replacement?

    A common concern is whether direct pressure through the knee can loosen or damage the prosthesis. Available evidence does not indicate that kneeling, once healing is complete, is harmful to a normally functioning total knee replacement. The American Academy of Orthopaedic Surgeons likewise notes that kneeling may be uncomfortable after total knee arthroplasty but is not considered damaging to the implant.

    That does not mean every patient will kneel easily. A review of function after total knee replacement found that 60–80% of patients reported some difficulty with kneeling or avoided it. Importantly, the perception that “I cannot kneel” does not always match the person’s actual ability to perform the task when it is assessed directly.

    Why can kneeling remain difficult after surgery?

    • Scar tenderness — direct pressure on the front of the knee may remain uncomfortable for a long time.
    • Skin numbness — small cutaneous sensory branches can be divided during the surgical approach, leaving an area of reduced sensation, often lateral to the scar. This commonly becomes less troublesome with time but may not disappear completely.
    • Pressure pain — even a well-functioning knee can remain sensitive on a hard surface.
    • Limited range of motion — deeper kneeling requires sufficient flexion, although range of motion does not explain all of the difference between people who kneel and those who avoid it.
    • Fear of damaging the implant — some patients never try because they believe kneeling is prohibited.
    • Other musculoskeletal limitations — the opposite knee, hip, spine, muscle weakness or difficulty getting back up from the floor may be more limiting than the replaced knee itself.

    When can you start trying?

    There is no single date that is appropriate for everyone. The key prerequisite is complete wound healing. Do not put direct pressure on a fresh scar, a wound that is still draining, an area with a scab, increasing redness or marked tenderness. Some centres advise waiting several months, while others allow gentle attempts earlier once the wound is fully healed. Differences reflect surgical technique, the course of healing and the rehabilitation plan.

    Function and safety are more useful than the calendar alone. Before kneeling, the patient should have stable walking, adequate strength and the ability to lower themselves toward the floor and get up again safely.

    How can kneeling be reintroduced safely?

    First attempts are best made in a controlled setting with a stable support for the hands. A soft mat, thick pad or cushion can reduce focal pressure on the front of the knee. There is no need to move immediately into a deep kneeling position or stay on the knees for a prolonged period.

    A sensible progression is to begin with brief contact on a soft surface, then gradually increase time and load as long as pain and swelling are not increasing. When the main difficulty is getting down to the floor and standing up again rather than kneeling itself, practising those transitions with a physiotherapist can be useful. Studies suggest that instruction and task-specific practice can improve actual kneeling ability.

    Is a large amount of knee flexion required?

    Greater flexion makes some kneeling positions easier, but it is not the only requirement. Some patients with good range of motion still avoid kneeling because of tenderness or fear, while others can achieve a functional kneel despite only moderate flexion. The flexion angle alone therefore does not predict whether kneeling will be comfortable.

    Does the type of implant or surgery matter?

    The influence of incision type, implant design and patellar resurfacing has been studied, but the findings do not provide a simple way to predict kneeling ability. A meta-analysis of 36 studies found some associations between surgical technique and kneeling, while also emphasising the need for better randomised evidence. There is no good basis for selecting an implant solely to optimise this one activity.

    If regular kneeling is essential for work, gardening, a hobby or religious practice, it is worth discussing this before surgery. It should form part of the conversation about realistic functional goals after knee replacement.

    What about kneeling after partial knee replacement?

    Kneeling can also be difficult after unicompartmental knee replacement, although available evidence suggests that appropriate instruction may improve the ability to perform the task. Those findings should not be transferred automatically to every total knee replacement because the extent of surgery and biomechanics differ.

    When should kneeling be avoided and the knee assessed?

    Kneeling should be postponed when the wound has not fully healed or when symptoms suggest a postoperative complication. Earlier assessment is particularly important for:

    • drainage from or separation of the wound,
    • increasing redness and marked warmth around the operated knee,
    • fever together with worsening knee symptoms,
    • sudden or rapidly increasing pain and swelling,
    • new instability or a clear deterioration in function,
    • calf pain and swelling, especially if accompanied by shortness of breath or chest pain, which requires urgent medical assessment.

    Kneeling is only one part of returning to function

    Patients after knee replacement also ask about driving, work and sport. Each activity requires a different combination of strength, control and tolerance. Someone who can walk several kilometres comfortably may still dislike pressure on the scar while kneeling. Conversely, difficulty kneeling does not by itself mean that the knee replacement is functioning poorly.

    Key points for an orthopaedic surgeon

    After a well-healed total knee replacement, kneeling itself is not generally considered harmful to the implant. The more common barriers are scar tenderness, numbness, pressure pain, stiffness and fear of damaging the prosthesis. Return should be gradual, initially on a soft surface, and only once the wound has healed. Increasing pain, swelling, wound problems or other warning signs should be assessed before kneeling is resumed.

    Back to: Before and After Orthopaedic Surgery

    References

    • Wylde V, Artz N, Howells N, Blom AW. Kneeling ability after total knee replacement. EFORT Open Rev. 2019;4(7):460–467. DOI: 10.1302/2058-5241.4.180085.
    • Nadeem S, Mundi R, Chaudhry H. Surgery-related predictors of kneeling ability following total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Relat Res. 2021;33:36. DOI: 10.1186/s43019-021-00117-z.
    • Wallace SJS, Berger RA. Most Patients Can Kneel After Total Knee Arthroplasty. J Arthroplasty. 2019;34(5):898–900. DOI: 10.1016/j.arth.2019.01.047.
    • American Academy of Orthopaedic Surgeons. Total Knee Replacement. OrthoInfo. Accessed 10 September 2026.

    This information is educational and does not replace an individual medical consultation.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Orthopaedic Surgical Wound Care — When Should You Change the Dressing?

    Polish version · Before and After Orthopaedic Surgery

    The most important rule is to keep an orthopaedic surgical dressing clean and dry and to follow the wound-care instructions given for the specific procedure. Not every wound needs to be uncovered or redressed every day. A small amount of staining can be normal, but increasing drainage, separation of the wound edges, spreading redness, fever or worsening pain should prompt contact with the treating team.

    Why are wound-care instructions different after different operations?

    A wound after arthroscopy, fracture fixation or joint replacement may be closed with different materials and protected by different dressings. Drains, negative-pressure wound therapy, coexisting medical conditions and medicines that affect clotting can also change the plan. For that reason, written discharge instructions take priority over general advice.

    When should the dressing be changed?

    If the dressing is dry, sealed and adheres well, it can often remain in place for the period recommended by the orthopaedic surgeon or the dressing manufacturer. It should be changed sooner if it becomes wet, soiled, loose or if drainage reaches the edge. Specialist dressings and negative-pressure systems should not be removed independently unless this has been specifically advised.

    How can a dressing be changed safely?

    • Wash and dry your hands thoroughly before touching the dressing and again after the change.
    • Prepare a clean surface and the materials recommended at discharge.
    • Do not touch the surface of the new dressing that will lie directly against the wound.
    • Remove the old dressing gently without pulling on sutures, skin-closure strips or tissue adhesive.
    • Do not apply creams, ointments, powders or topical antibiotics to the wound unless they have been specifically prescribed.
    • If the wound looks different from before, note the change and contact the treating team when appropriate.

    Can the wound be washed or soaked?

    NICE guidance indicates that showering is generally safe from 48 hours after surgery. This is not a universal instruction to wet every wound or dressing: the type of closure, a drain, a negative-pressure dressing or an individual instruction from the surgeon may require a different approach. After showering, the area should be dried gently without rubbing.

    Bathing, swimming, sauna use and prolonged soaking require more caution. They are usually postponed until the skin has fully closed and the wound has been reviewed. Prolonged water exposure can soften the wound edges and increase the risk of contamination.

    What can be normal during the first few days?

    • a small, non-increasing blood stain or a small amount of clear or lightly pink fluid on the dressing;
    • moderate tenderness that is not progressively worsening;
    • mild swelling and bruising around the operated area;
    • a pulling sensation in the skin during movement.

    The direction of change matters more than a single appearance. Over time, the wound should become calmer, while drainage and pain should gradually decrease.

    When does the wound need prompt review?

    • redness, warmth or swelling that is spreading around the incision;
    • pain that is increasing rather than decreasing, especially after an initial improvement;
    • cloudy, thick or unpleasant-smelling drainage;
    • a dressing that repeatedly becomes rapidly soaked with blood or fluid;
    • separation of the wound edges or a visible deeper defect;
    • fever, chills or a clear deterioration in general wellbeing;
    • new numbness, limb weakness, pallor or blue discolouration of the fingers or toes.

    After an operation involving an implant, even a small but persistent wound discharge should not simply be left until a distant routine follow-up. Early assessment can help distinguish superficial irritation from a problem that requires treatment.

    When are sutures or staples removed?

    The timing depends on the anatomical site, skin tension, closure method and healing rate. Sutures, staples, tissue adhesive and closure strips should not be removed independently. The wound should be reviewed at the time specified in the discharge instructions even when it appears normal from the outside.

    What increases the risk of wound-healing problems?

    Closer observation may be appropriate in people with diabetes, tobacco use, impaired circulation, anticoagulant treatment, reduced immunity, obesity or a previous history of wound-healing problems. These factors do not mean that a complication will occur, but they may justify earlier review.

    References

    • National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline NG125. Published 11 April 2019; updated 19 August 2020. Recommendations.
    • Centers for Disease Control and Prevention. Surgical Site Infection Basics. Updated 11 April 2024. CDC information.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Painful Surgical Scar — Could It Be a Neuroma?

    A sharply localised burning, stabbing or electric-shock-like pain in or next to a surgical scar can come from an irritated or trapped cutaneous nerve and, in some cases, from a painful neuroma. Not every tender scar is a neuroma, however. Normal healing, infection, implant-related problems, local tissue overload and complex regional pain syndrome must also be considered.

    What is a postoperative neuroma?

    When a nerve is cut or significantly injured, its fibres attempt to regenerate. If they cannot reconnect with the distal segment, a disorganised bulb of regenerating nerve tissue may form at the nerve end. This is a traumatic neuroma. Similar symptoms can also occur when a nerve remains anatomically continuous but becomes tethered in dense scar tissue or repeatedly irritated during movement.

    Which symptoms suggest neuropathic scar pain?

    • a very small, clearly defined point of maximal tenderness within or next to the scar;
    • burning, stabbing, shooting or electric-shock-like pain;
    • pain radiating along a nerve distribution when one specific point is pressed or tapped;
    • numbness, hypersensitivity or pain from light contact such as clothing;
    • symptoms aggravated by stretching the scar, moving the nearby joint, footwear or a brace pressing on the area.

    During the first weeks after surgery, local tenderness, a small patch of numb skin and altered sensation may improve gradually without additional treatment. A neuroma becomes more likely when the pain has a distinctly neuropathic quality, persists or worsens, and can be reproduced consistently by pressing one focal point.

    How is it investigated?

    What does an orthopaedic surgeon assess during examination?

    The scar itself is examined together with the distribution of sensory change, muscle strength and the expected course of the nerve. The clinician may also check whether tapping the painful point reproduces radiating symptoms. It is useful to know whether the nerve could have been cut, mobilised or placed at risk during the original operation.

    High-resolution nerve ultrasound

    High-resolution ultrasound can demonstrate focal nerve enlargement, loss of continuity, tethering to scar tissue and the relationship to tendons, implants or vessels. Dynamic examination may show whether movement stretches or displaces the symptomatic segment. A normal ultrasound does not completely exclude pain arising from a very small cutaneous nerve branch.

    Other tests

    MRI, including MR neurography in selected cases, may be helpful for deeper lesions. Nerve conduction studies and electromyography are more useful when pain is accompanied by muscle weakness or sensory loss in the territory of a larger peripheral nerve. A selective local anaesthetic injection can sometimes help test whether a particular nerve segment is generating the pain, but the result still needs to be interpreted in the context of the full examination.

    How are painful scars and neuromas treated?

    Treatment depends on the time since surgery, the severity of symptoms and whether the nerve is thought to be divided, tethered or temporarily irritated. Early management may include protecting the area from pressure, gradual desensitisation, scar mobility work and appropriate medical treatment for neuropathic pain. Aggressive massage directly over a very painful focal point before the diagnosis is clear can aggravate symptoms.

    Selected patients may benefit from diagnostic or therapeutic injections, sometimes performed under ultrasound guidance. Evidence for hydrodissection and other injection-based techniques remains limited, so these procedures should not replace an effort to identify the underlying pain mechanism.

    Surgery may be considered when pain is persistent, well localised, functionally important and has not improved with appropriate conservative treatment. Options include freeing a nerve from scar tissue, excising a neuroma and protecting or reconstructing the nerve end. The technique depends on the anatomy and on whether meaningful nerve continuity can be restored; no procedure guarantees complete relief.

    When is urgent assessment needed?

    Do not assume that worsening scar pain is a neuroma if the wound is hot, red or draining, if fever develops, swelling is increasing rapidly, or pain suddenly becomes much more severe. New or progressive muscle weakness, widespread numbness, a cold or pale limb, or severe pain associated with marked colour or temperature change and swelling of the whole region also require prompt assessment. Sudden neurological weakness should be investigated without delay.

    Key point

    A painful neuroma is one possible cause of persistent scar pain after surgery, but the diagnosis requires a consistent symptom pattern, clinical examination and—when appropriate—imaging or a diagnostic block. Treatment is most useful when it targets a specific mechanism rather than simply attempting to “break up” the scar.

    References

    1. Zhou L, Huo T, Zhang W, et al. New techniques and methods for prevention and treatment of symptomatic traumatic neuroma: a systematic review. Front Neurol. 2023;14:1086806. DOI: 10.3389/fneur.2023.1086806.
    2. Hendrickson NR, McDonald JR, Kennedy SA, et al. Treatment of Postsurgical Neuroma in Foot and Ankle Surgery. Foot Ankle Orthop. 2023;8(3). DOI: 10.1177/24730114231188125.
    3. Grimm A, Décard BF, Athanasopoulou I, et al. Nerve Ultrasound in Traumatic and Iatrogenic Peripheral Nerve Injury. Diagnostics. 2021;11(1):30. DOI: 10.3390/diagnostics11010030.

    Polish version · For Patients

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Stairs After Surgery — How to Go Up and Down Safely

    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.