The short answer: use the technique you practiced with therapy
Before discharge, you should practice getting into and out of bed with a physical therapist or trained member of the care team. MedlinePlus lists safe bed, chair, and toilet transfers among the functional milestones patients should meet before going home after hip or knee replacement. Review the MedlinePlus hospital-recovery guidance.
Do not replace that hands-on instruction with a generic internet sequence. Hip precautions can differ by surgical approach, revision status, tissue quality, surgeon preference, and individual stability. Knee patients may have different problems, especially swelling, quadriceps weakness, and difficulty lifting the leg.
Set up the bed before surgery
A safe transfer starts with the environment. Clear the route between the bed and bathroom, remove loose rugs and cords, add a night-light, and keep the walker where it can be reached without leaning or twisting. A stable bedside surface can hold the phone, water, glasses, and prescribed medicines, but it should not be used as a grab bar unless it is designed and secured for that purpose.
OHSU recommends discussing bed, chair, car, bathroom, and stair transfers during preoperative therapy when questions remain. See the OHSU preparation and recovery guide. Practice with the actual bed when possible, not only a therapy table.
Choose a workable bed height
The bed should let you sit on the edge with control rather than dropping onto a low mattress or climbing onto a surface that is too high. MedlinePlus advises that a hip-replacement patient’s feet should reach the floor while sitting at the edge, while the hips remain higher than the knees; it also recommends a firm mattress rather than one that allows deep sinking. Review the MedlinePlus hip-discharge guidance.
That is a starting point, not a universal measurement. Your height, leg length, joint replaced, precautions, and ability to scoot matter. Test the setup with therapy. A thick topper, unstable step stool, rolling bed frame, or very soft mattress can turn a simple transfer into a fall risk.
A general sequence for getting out of bed
Your therapist may modify the sequence, but the basic goals are to move deliberately, keep the operated leg supported as instructed, avoid twisting, and reach a stable sitting position before standing.
- Pause first
If you have just awakened or taken medicine, move your ankles and take a few calm breaths. Ask for help if you feel unusually weak, sleepy, or lightheaded.
- Move toward the edge
Use your arms and the non-operated leg as instructed to shift your trunk and hips. Move in small steps rather than twisting the pelvis while the feet stay planted.
- Bring the legs toward the edge
Support the operated leg using the therapist-approved method. A leg lifter or sheet may be appropriate only if the team has shown you how to use it without violating precautions.
- Raise the trunk
Push through the mattress or a secure bed rail while lowering the legs. Do not have a caregiver pull on your arms or operated leg.
- Sit and reassess
Place both feet as instructed, sit upright, and wait. If dizziness, nausea, blurred vision, or weakness occurs, remain seated and call for help.
- Stand with the prescribed aid
Scoot forward, place the feet as taught, push from the bed or stable rail, and then take hold of the walker. Do not pull yourself up on a walker that can tip toward you.
Getting back into bed is not simply falling backward
Back up until you feel the bed against the legs, reach for the mattress or secure support, and lower yourself with control. Once seated, move the hips far enough onto the bed that you will not slide off while bringing the legs up. Use the practiced method to guide the operated leg, then reposition in small movements without twisting.
Keep the walker close enough to reach after the next transfer but not where it blocks the feet or becomes a nighttime trip hazard. The MedlinePlus guide to getting out of bed after surgery emphasizes learning the maneuver from a nurse, therapist, or assistant. See the general post-surgery bed-mobility guidance.
Which side of the bed should you use?
There is no safe universal answer. Some protocols favor the operated side because the leg travels a shorter path; others favor the non-operated side or the side that best matches the room and the patient’s strength. Revision surgery, hip precautions, weakness, lines or dressings, and the location of walls or furniture may change the plan.
Ask the therapist to watch you use the same side you will use at home. If the preferred side at the hospital is impossible in your bedroom, solve that before discharge by rearranging the room, temporarily changing sleeping locations, or practicing the alternate method with supervision.
Hip precautions must be individualized
Do not assume that every hip-replacement patient has the same restrictions. Some patients receive movement precautions for a defined period, while others have fewer restrictions. Revision surgery or other clinical factors may require a more protective plan. HSS specifically notes that rehabilitation guidance is operation- and side-specific and should be approved by the surgeon. Review the HSS rehabilitation-guide overview.
If precautions were prescribed, protect them during the entire transfer—not only after you are lying down. Avoid the prohibited combination of bending, crossing, or twisting that your team identified. Move the trunk, pelvis, and feet as a unit when turning rather than pivoting sharply on the operated leg.
Knee replacement has a different challenge
After knee replacement, the difficult part is often controlling a swollen, heavy-feeling leg. The quadriceps may temporarily struggle to lift the heel, and the knee may be uncomfortable as it bends over the mattress edge. Support the leg as taught and avoid having a caregiver lift only by the foot or ankle.
A temporary inability to perform a straight-leg raise can occur early, but the trend and the overall neurologic examination matter. Report a new or worsening inability to move the ankle or toes, marked numbness, uncontrolled pain, or a sudden change from the function demonstrated in therapy.
Use a leg lifter only as a trained tool
A leg lifter, strap, or folded sheet can help some patients guide the operated leg. It should extend your reach, not force the hip or knee through a painful arc. Ask therapy to confirm the placement, hand position, and direction of pull. Avoid looping a device where it compresses the incision, calf, or a numb area.
If you need progressively more force each day, cannot clear the mattress, or the device causes sharp pain, stop and call the team. Equipment should make a safe movement easier; it should not hide declining function.
Caregivers should guard, not drag
A caregiver should stand where the therapist recommends, keep the path clear, and be ready to steady the patient if balance changes. Pulling on an arm can injure the shoulder or destabilize both people. Lifting under the armpits, yanking the operated leg, or attempting a full-body lift without training can cause a fall or caregiver injury.
If hands-on assistance is needed, ask therapy to teach the exact guarding method and whether a gait belt is appropriate. A patient who requires more help than the available caregiver can safely provide may need additional home support or a different discharge plan.
Dizziness changes the transfer plan
Pain medicine, anesthesia effects, dehydration, blood loss, low blood pressure, poor intake, and prolonged lying can all contribute to lightheadedness. Sit at the edge of the bed before standing and give the body time to adjust. Keep a trained helper nearby during early transfers if dizziness has occurred.
Do not push through faintness, tunnel vision, new confusion, chest discomfort, shortness of breath, or a racing or irregular heartbeat. Sit or lie safely, call for help, and follow the postoperative contact plan. The JRH nausea and hydration guide explains related warning signs.
Make nighttime transfers boring and predictable
Nighttime adds darkness, urgency, medication effects, and sleepiness. Use a clear, illuminated path; wear secure footwear if instructed; keep the mobility aid consistently positioned; and avoid carrying objects in both hands. Sit for a moment before standing, even when the bathroom feels urgent.
The JRH sleep guide covers positioning and sleep disruption, while the fall-prevention guide addresses hazards, assistive devices, and progression. A bedside commode may help selected patients, but it should be recommended and adjusted by the care team.
A pre-discharge bed-transfer checklist
Before leaving the hospital or surgery center, confirm the following with the rehabilitation team:
- I can describe and demonstrate my exact transfer sequence
- I know which side of the bed to use at home and why
- The bed height and mattress firmness are workable
- I know whether hip precautions apply and how long to follow them
- I can use my walker, bed rail, or leg lifter correctly if prescribed
- My caregiver knows where to stand and how much help to provide
- I have a plan for nighttime lighting and the bathroom route
- I know what to do if dizziness, weakness, or pain makes the transfer unsafe
- I have the postoperative phone number and a neighbor-island urgent-care plan if needed
When to call the surgical team
Call promptly if transfers are becoming harder rather than easier, you cannot reproduce the function shown before discharge, the operated leg suddenly gives way, or pain is uncontrolled despite the prescribed plan. Also call for repeated dizziness, fainting or near-fainting, inability to keep fluids down, a new medication concern, fever, increasing wound redness or drainage, or new calf pain or one-sided swelling.
New foot weakness, inability to move the toes or ankle, rapidly increasing numbness, severe swelling, or a sudden major change in leg function needs urgent clinical review. Do not wait for the next routine appointment when function changes abruptly.
When to seek emergency care
Call 911 for chest pain, sudden shortness of breath, fainting, coughing up blood, signs of stroke, severe breathing difficulty, or a severe allergic reaction. Do not attempt another transfer or drive yourself.
A fall with a new deformity, inability to bear weight, severe hip or knee pain, a shortened or rotated leg, head injury, or uncontrolled bleeding also needs urgent assessment. Stay where you are safe and wait for trained help rather than asking a family member to lift you from the floor.
Practice the real task, not just the exercise
Strength and range-of-motion exercises matter, but the practical goal is safe movement in the actual home. If possible, share photos or measurements of the bed and surrounding space with the therapy team. Neighbor-island patients should practice before travel and arrange enough help for the first nights at home.
If bed transfers remain a barrier, schedule an orthopedic consultation or contact the postoperative team. A focused plan can address technique, equipment, pain control, dizziness, weakness, and whether additional therapy or home support is needed.
Sources and further reading
Medically reviewed by Paul Norio Morton, MD, FAAOS, FAAHKS. Last reviewed: . This article is for education only and isn’t a substitute for an exam and personalized advice — schedule a consultation to discuss your situation.