Stairs After Total Hip Replacement: A Physical Therapy Guide

As an orthopedic physical therapist seeing home-bound total hip replacement patients immediately after hospital discharge, I see many patients with two-story homes who elect to reside on the first floor of the home until they are more comfortable climbing stairs.

Even though they have been instructed on the stairs in the hospital by the hospital physical therapist, some patients are just not ready to tackle getting up and down the stairs.

On the other hand, I have seen a few patients who have had both hips replaced at the same time and are getting up and down the stairs on the first day of my home visit, usually a couple of days after the surgery.

In this article, I’m going to discuss how soon a total hip replacement patient can go up and down the stairs and three techniques that are appropriate for this patient.

How soon can I go up and down stairs after hip replacement?

A total hip replacement recipient will go up and down stairs before they are discharged from the hospital.
One criterion surgeons use to determine discharge from the hospital is the patient’s ability to ascend and descend stairs.
This criterion is met by working on stairs with the hospital physical therapist.

This skill is very important to teach the hospital-bound patient if there are stairs to be conquered at home.

That is true for patients living in a two-story home as well as for patients who have stairs just to get into and out of the home.

How do I go up and down stairs after a new total hip replacement surgery?

There are three techniques for new total hip replacement recipients to ascend and descend stairs:

  • One step at a time, facing sideward.
  • One step at a time, facing forward.
  • Reciprocal steps facing, forward.

One Step At A Time Facing Side-ward

Stairs Sidewards THR Watermarked 200707 1
Ascending/decending stairs after total hip replacement
Facing sideward

This technique is probably the safest but also the least functional of these three techniques.

Some patients are too debilitated to start in the forward-facing position but can ascend and descend stairs facing the handrail and grasping it with both hands.
These are elderly, frail, or extremely fearful of falling patients. I have personally only seen a handful of patients out of the multitude of hip replacement patients I have seen a day or two after surgery.

Unfortunately, to use this “One Step At A Time Facing Sideward” technique requires a handrail on the correct side of the stairs or handrails on both sides of the stairs.

Ascending Stairs:

The total hip patient faces the handrail with the operated hip extremity the furthest away from the first step and feet relatively close together.

Grasping the handrail in front of the patient with both hands, the unoperated leg is lifted onto the first stair’s tread.

  • Be sure that the foot’s placement is close enough to the stair riser and leaves room to place the operated leg’s foot on the stair tread alongside or slightly forward of the unoperated leg’s foot already on the stair tread.
  • Grasping the handrail in front of the patient, the patient lifts the bodyweight with the unoperated leg and places the operated leg’s foot alongside the foot of the unoperated leg.
  • The hands are advanced up the handrail, and this process is repeated until the patient reaches the top of the stairs.

Descending Stairs:

At the top of the stairs, the patient faces the handrail (sideward-facing) with the operated leg’s foot closest to the stair tread below.

  • The patient grasps the handrail in front of them with both hands.
  • The operated leg’s foot is lowered to the stair tread below the patient.
  • Be sure the placement of the operated foot leaves enough room on the stair tread to receive the unoperated leg’s foot.
  • The unoperated leg’s foot is advanced to the step below; both feet are now on the same stair tread.
  • The patient’s hands are advanced down the handrail, and the process is repeated.

One Step At A Time Facing Forward

Ascending Stairs:

Ascend stairs THR Cane Handrail Watermarked 200707 1

I discourage my patients from using a walker on the stairs. It is just too bulky and adds to the fall-risk in my opinion.

  • The patient, usually using a walker, approaches the stairs forward-facing. The operated leg’s toes should almost be touching the riser of the first stair.
  • The walker is replaced with a single-point cane (or walking stick) and banister.
  • The patient lifts the unoperated leg upon the first step’s tread and raises the body up, bringing the operated leg to the tread of the first step.
  • The patient lifts the body weight upward using the unoperated leg and brings the operated leg’s foot up onto the step tread.
  • Repeat this process to the top of the stairs.
  • At the top of the stairs, the single-point cane is abandoned, and the patient returns to the stability of a walker as their primary ambulatory assistive device.

Descending Stairs:

Descend Stairs THR Cane Banister Watermarked 200707 1
  • The patient approaches the top of the stairs with the walker until both feet are at the edge of the first stair to be descended.
  • The walker is replaced with a single-point cane or walking stick, and the patient grasps the banister with the other hand.
  • The single-point cane or walking stick is placed in contact with the stair tread below the patient’s feet.
  • The operated leg is lowered to the step tread below the patient’s feet, followed by the unoperated leg. Both feet and the single-point cane or walking stick are now in contact with the tread.
  • The single-point cane or walking stick is advanced to the next-level stair tread, and the process is repeated until reaching the bottom of the stairs, and the walker is once again employed as the primary walking device.

The Problem With This Technique:
How does the walker get up or down the stairs?

The problem is that the caregiver must lug the walker up and down the stairs; however, this can be challenging for a senior citizen, even in good physical condition. The patient’s caregiver is usually the patient’s spouse. Chances are good that both the caregiver and the patient are senior citizens.

The best solution, and my recommendation, is to have two walkers, one upstairs and one downstairs.

This second walker strategy can give a senior citizen pause because of the additional expense and the short time the walker will be required.

I find that most of my patients have a friend or family member who has undergone a total knee or hip replacement and is no longer using their walker. They are almost always happy to lend the walker to the patient.

Another source of a second walker is a local non-profit, such as a church, that has a “library” of equipment that is loaned out at usually no cost to the patient.

Reciprocal Steps Facing Forward

In my experience, most of my total hip replacement patients can go up the stairs reciprocally, the normal stair climbing technique, by about 14 to 17 days after surgery.

However, coming down the stairs reciprocally is more difficult.
Even though it is more difficult, I would say 50% or more of my total hip patients can descend stairs reciprocally in the same 14 to 17 days after the surgery time frame.

By the time my patients achieve the ability to ascend stairs reciprocally, the only assistive device they are using is the banister, and they are no longer using any ambulation assistive device at all.

Final Thoughts

  • A total hip replacement patient should be able to go up and down stairs safely before they are discharged from the hospital. The hospital physical therapist usually worked with the patient on stairs before discharge from the hospital.
  • Most patients can ascend and descend stairs with the “One Step At A Time” technique and then advance to the “Reciprocal Steps Facing Forward” technique as they are able.
  • Most patients will be able to advance to the “Reciprocal Steps Facing Forward” technique going up the stairs more quickly than they can do going down the stairs.
  • The “One Step At A Time Facing Sideward” is a technique I use for elderly or frail individuals, as well as those who have an extreme fear of falling and have lack of confidence issues.
  • The “One Step At A Time Facing Sideward” requires a handrail on the correct side of the staircase (at the bottom of the stairs with the operated leg furthest away from the stairs, the patient should be facing the handrail).
  • If a total hip replacement needs manual assistance to ascend or descend stairs, put a belt around their waist ( AKA gate belt) and the assistant holds onto the belt. It is much easier to control a patient’s balance when doing so from their center of gravity.
  • If the assistant is using the patient’s arm for contact control, it takes away the patient’s ability to help using that arm’s strength.
  • The good foot goes to heaven, the bad foot goes to …..
  • The operated hip’s knee should never bend regardless if going up or down stairs.
  • Think of the good leg as your elevator that takes you up and down the stairs. It is the only leg that will be “working” when going up and down stairs.

Stair climbing is never used as an exercise in a new total hip replacement patient’s home exercise program.

Read my other articles about Total Hip Replacement

Congratulations on your new hip replacement. Stairs won’t be a problem for very long.

Paying It Forward

Perhaps you are approaching or already retired and wondering how you could earn extra money in retirement.
One option would be to do as I am doing.
Read my article How To Generate Retirement Income: Cash In On Your Knowledge.

Dr. Robert Donaldson

Dr. Donaldson is dually licensed; physical therapy in 1975 and doctor of chiropractic in 1995. He held credentials of Orthopedic Clinical Specialist in physical therapy for 20 years, QME in California, and taught at USC. He owns and operates an orthopedic physical therapy practice. See "About Me" page.

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