Floor transfers after knee replacement require more than knee bending. Getting down to the floor and standing again also uses leg strength, balance, upper-body support, coordination, and a movement sequence suited to your abilities.
Walking and stairs may improve while the floor still seems surprisingly far away. The movement can be divided into smaller parts and practiced with appropriate professional guidance.
Prefer to listen? Play Episode 96 below for the complete discussion.
Have you recently had a total knee replacement, or are you preparing for surgery and wondering what recovery will really be like? Welcome to the Total Knee Success Podcast, your resource for total knee replacement recovery and life after surgery. Hosted by Michelle Losurdo, a trusted doctor of physical therapy and board-certified orthopedic clinical specialist, this show is designed for anyone considering, preparing for, or recovering from knee replacement surgery.
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Episode 96 explains why getting down to the floor and standing again can remain difficult after knee replacement. Michelle discusses the roles of knee motion, lower-body strength, balance, arm support, and movement sequencing, then describes several general floor-transfer methods that can be adapted to different abilities. The Episode also explains how task-specific practice and backward chaining may be used to build the skill in smaller parts. It closes by distinguishing a planned floor transfer from the decisions required after an actual fall.
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Why Floor Transfers After Knee Replacement Can Be Demanding
A floor transfer is the process of moving from standing or sitting to the floor and returning upright. Unlike standing from a chair, there is no fixed seat or standard starting position. You must create a route between two very different heights.
Many approaches include squatting, kneeling, half-kneeling, or moving onto the hands and knees. If your replaced knee does not bend comfortably into one position, that route may not fit you even when ordinary walking is progressing.
A useful floor-transfer method is not the one that looks most impressive. It is the one that fits your motion, strength, balance, and available support.
Your thigh and hip muscles control your body as you lower and help lift you from a low position. Research involving older adults has associated floor-transfer ability with strength, balance, mobility, and chair-rise performance.
Three Common Floor-Transfer Approaches
There is no single correct method for floor transfers after knee replacement. A physical therapist or occupational therapist can evaluate the movement and help select an approach based on your knee motion, leg strength, balance, upper-body function, and surroundings.
1. Supported Half-Kneeling
In half-kneeling, one knee is on the floor or a padded surface and the opposite foot is planted in front, similar to the bottom position of a small lunge. Stable furniture may provide hand support while moving between half-kneeling and standing.
This approach requires kneeling tolerance and enough control to bring one foot forward. If kneeling is a concern, read Kneeling After Knee Replacement – Episode 93.
2. Hands-and-Knees Approach
Some people move through a four-point position with both hands and knees on the floor. This creates a wider base but requires tolerance through the wrists, shoulders, hips, and knees.
A firm padded surface may improve comfort without sacrificing stability.
3. Side-Sitting or an Intermediate Surface
A side-sitting approach may allow one leg to remain more extended. It requires trunk control, hip mobility, and the ability to accept weight through an arm.
A sturdy step, low bench, or firm exercise platform may provide an intermediate level. Dividing the distance into stages reduces the height of each movement. Any support must be stable and appropriate for the task.
Practice One Part at a Time
Backward chaining means learning the final part of a task before adding the earlier portions. For a floor transfer, supervised practice might begin in half-kneeling beside stable support and focus only on the final rise. Earlier steps can be added after that portion becomes more familiar.
Studies involving older adults suggest that task-specific floor-rise training may improve floor-rise ability. Evidence specific to knee replacement is limited, so those findings cannot determine whether a method is appropriate for you.
Strength and movement skill are not identical. Someone may be strong enough yet still need to learn where to place the hands, which foot to move, or how to turn. Guided practice can identify which part needs modification.
Plan the First Practice Carefully
Before attempting floor transfers after knee replacement, ask your surgeon whether kneeling is permitted and what precautions apply. Incision status, skin sensitivity, other joint conditions, and balance may affect readiness.
A therapist can determine whether assistance, supervision, stable furniture, or another modification is appropriate. Do not make a first attempt alone, while dizzy or exhausted, or when affected by medication. Remove loose rugs, cords, pets, and sharp-edged objects.
A Planned Transfer Is Different From a Fall
A planned floor transfer is not the same as trying to stand after a fall. After a fall, pause and assess the situation before moving. A head impact, severe pain, bleeding, dizziness, an obvious deformity, chest pain, shortness of breath, or an inability to move or bear weight may require emergency assistance.
Repeated attempts to stand may worsen an injury or increase exhaustion. A previously practiced method may provide options when no serious injury is apparent, but a fall is not the time to invent a new sequence.
Frequently Asked Questions
Can you kneel on a replaced knee?
Some people are permitted to kneel after the incision has fully closed, but comfort, sensation, surgical factors, and individual precautions vary. Ask your surgeon or physical therapist about your situation.
Is using your hands a sign of weakness?
No. Your hands and stable supports can redistribute body weight and improve control. A successful transfer does not need to be hands-free.
Build the Skill in Smaller Parts
Floor transfers after knee replacement combine leg strength, joint mobility, arm support, balance, coordination, and familiarity with a sequence. Practicing selected parts under professional supervision can make it easier to determine which approach fits your abilities.
Affiliate disclosure: This article contains an Amazon affiliate link. As an Amazon Associate I earn from qualifying purchases at no additional cost to you.
If walking still feels uneven, stiff, or mechanical, Walking Like Yourself Again After Knee Replacement offers a concise, evidence-informed explanation of the factors that influence gait.
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Educational disclaimer: This article provides general educational information and does not provide diagnosis, treatment, individualized medical advice, transfer training, or emergency assessment. Do not attempt a floor transfer based only on written instructions. Consult your surgeon, physical therapist, occupational therapist, or another qualified healthcare professional about your readiness, precautions, assistance needs, and appropriate technique. Seek prompt medical care after a fall when serious injury or urgent symptoms may be present.
References
- Ardali G, States RA, Brody LT, Godwin EM. Characteristics of older adults who are unable to perform a floor transfer: considerations for clinical decision-making. J Geriatr Phys Ther. 2020;43(2):62-70. doi:10.1519/JPT.0000000000000217.
- Ardali G, Brody LT, States RA, Godwin EM. The relationship between performance of sit-to-stand from a chair and getting down and up from the floor in community-dwelling older adults. Physiother Theory Pract. 2022;38(5):647-656. doi:10.1080/09593985.2020.1771806.
- di Laura Frattura G, Filardo G, Giunchi D, et al. Risk of falls in patients with knee osteoarthritis undergoing total knee arthroplasty: a systematic review and best evidence synthesis. J Orthop. 2018;15(3):903-908. doi:10.1016/j.jor.2018.08.026.
- Moutzouri M, Gleeson N, Coutts F, Tsepis E, Gliatis J. The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2017;25(11):3439-3451. doi:10.1007/s00167-016-4355-z.
- Hofmeyer MR, Alexander NB, Nyquist LV, Medell JL, Koreishi A. Floor-rise strategy training in older adults. J Am Geriatr Soc. 2002;50(10):1702-1706. doi:10.1046/j.1532-5415.2002.50465.x.
- Leonhardt R, Becker C, Groß M, Mikolaizak AS. Impact of the backward chaining method on physical performance and floor-rise ability in older adults: a randomized controlled trial. Clin Interv Aging. 2017;12:1237-1245. doi:10.2147/CIA.S139123.
- Fleming J, Brayne C; Cambridge City over-75s Cohort Study Collaboration. Inability to get up after falling, subsequent time on floor, and summoning help. BMJ. 2008;337. doi:10.1136/bmj.a2227.
- Swinkels A, Newman JH, Allain TJ. A prospective observational study of falling before and after knee replacement surgery. Age Ageing. 2009;38(2):175-181. doi:10.1093/ageing/afn259.