Why fall prevention deserves a plan
Hip or knee replacement is intended to improve mobility, but the first weeks include temporary weakness, pain, swelling, altered walking, disrupted sleep, unfamiliar equipment, and medication effects. A systematic review found that fall risk after hip or knee arthroplasty is influenced by multiple patient and functional factors, which is why a single precaution is not enough. Review the systematic review and meta-analysis.
The goal is not to make you afraid to move. Walking and rehabilitation are essential. The goal is to make each transfer and walking session predictable enough that you can build strength without an avoidable setback.
Start the home safety check before surgery
Walk through the route from the car to the bed, bathroom, kitchen, and usual chair. Remove throw rugs, cords, clutter, low furniture, pet toys, and anything that narrows the walker path. Repair loose flooring. Improve lighting from the bed to the bathroom and place switches or motion lights where they can be reached before taking a step.
AAOS notes that simple changes in furniture arrangement and lighting can substantially reduce home fall risk. Use its home safety checklist as a room-by-room review rather than relying on memory.
Make the bathroom less slippery and easier to use
Bathrooms combine wet surfaces, tight spaces, turning, and repeated sit-to-stand transfers. Add a nonslip surface in the shower or tub, keep the floor dry, and place soap and towels within easy reach. A shower chair, handheld shower, raised toilet seat, or securely installed grab bar may be useful when recommended for your situation.
Do not use a towel bar, sliding shower door, or unstable furniture as a support. Practice the transfer while the room is dry and while another person is available. MedlinePlus recommends preparing the home before surgery so equipment and pathways can be tested in advance. See its home-preparation guidance.
Use the walker or cane that matches your current ability
A mobility aid is not a sign that recovery is going poorly. It is a temporary safety tool that widens the base of support and helps control load while strength and balance return. Use the device prescribed by the rehabilitation team, adjusted to the correct height, with intact rubber tips or walker glides.
Keep both hands available for the walker. Use a small backpack, walker basket, or caregiver for objects rather than carrying a plate, phone, or laundry while walking. Do not move from walker to cane, or from cane to no device, simply because a calendar date has arrived. AAHKS gait guidance emphasizes rebuilding a consistent walking pattern rather than reinforcing a limp. Review the AAHKS gait-training guide.
Transfers are where many near-falls begin
Choose chairs with a firm seat, supportive arms, and enough height to stand without dropping backward. Back up until you feel the chair behind both legs, reach for the armrests, and lower yourself with control. When standing, bring your feet into the position taught by therapy, push from the chair, gain balance, and then take hold of the walker.
Avoid low sofas, rolling office chairs, stools without backs, and chairs that slide on tile. Keep the walker within reach before standing. For bed and vehicle transfers, practice the exact sequence with therapy or a caregiver rather than improvising when tired.
Pause before walking if you feel dizzy
Blood pressure can drop when moving from lying to sitting or from sitting to standing. Dehydration, blood loss, reduced appetite, blood-pressure medicines, and pain medicines can contribute. Sit at the edge of the bed first, move the ankles, stand with support, and wait until steady before walking.
If you repeatedly feel lightheaded, nearly faint, or need to grab furniture, stop and contact the care team. The CDC explains that postural hypotension can reduce blood flow enough to increase fall risk. Read the CDC patient guide.
Review medicines that affect alertness and balance
Opioids, muscle relaxants, sleep medicines, some antihistamines, and medicines that lower blood pressure can contribute to drowsiness, confusion, blurred vision, dizziness, or postural blood-pressure drops. Alcohol can compound these effects. Do not stop a prescribed medicine on your own, but do report excessive sleepiness, confusion, faintness, or repeated unsteadiness.
Keep a current list of prescriptions, over-the-counter medicines, and supplements. The JRH guide to medication after surgery can help you organize questions for the surgical team. CDC STEADI also recommends medication review as part of a complete fall-risk assessment. See the CDC medication fact sheet.
Plan for pets, stairs, and nighttime trips
Pets can move unpredictably under a walker or around the operated leg. Use gates, a separate room, or another caregiver for feeding and walking until your path is reliable. Keep frequently used items between waist and shoulder height so you do not need to climb, bend deeply, or reach while off balance.
For stairs, use the rail and the sequence taught by therapy. Do not carry objects on stairs. At night, wear secure footwear, turn on lights before standing, and use the walker even for a short bathroom trip. Fatigue and urgency are poor reasons to skip the device.
Wear secure footwear and manage the Hawaii environment
Choose closed-back, nonslip shoes that fit securely. Avoid loose slippers, socks on smooth floors, and flip-flops that can catch or slide. Check the sole for sand or moisture before entering the house.
Outdoor recovery in Hawaii can add wet lanais, uneven sidewalks, steep driveways, grass, gravel, curbs, and sudden rain. Ask for help on unfamiliar surfaces. Do not let confidence on a flat clinic hallway substitute for testing the actual path at home.
A caregiver should protect independence, not replace it
A caregiver can prepare food, manage pets, carry objects, keep pathways clear, and stand nearby during new transfers. The helper should not pull on your arm or the walker. Instead, follow the technique demonstrated by physical or occupational therapy and use a gait belt only if trained.
Agree on when hands-on help is needed and when supervision is enough. The aim is safe practice that gradually increases independence. AAHKS notes that discussing the home environment and preparing it before surgery are important parts of a safe discharge plan. Read the AAHKS going-home guidance.
Build balance and strength without testing your luck
Follow the walking and exercise plan prescribed for your operation. Practice when alert, pain is controlled, the route is clear, and the device is available. Increase one variable at a time, such as distance, speed, surface, or time without hands-on help.
The JRH knee replacement recovery guide explains how walking, swelling control, strength, and endurance progress over time. AAHKS home exercise guidance also includes strength, endurance, and balance as rehabilitation goals. Review the AAHKS knee exercise guide.
What to do if you fall
Do not rush to stand. Pause, check for head injury, bleeding, wound opening, deformity, new severe hip or knee pain, numbness, and whether the leg can move normally. If another person is present, ask them to bring the phone and keep the area clear. Do not let someone pull you up by the arms or operated leg.
Call 911 for loss of consciousness, head injury with concerning symptoms, chest pain, sudden shortness of breath, severe bleeding, an obviously deformed or shortened leg, a cool or numb limb, or pain so severe that movement is unsafe. If you cannot bear weight or cannot get up safely, use emergency help rather than crawling or repeatedly trying to stand.
Contact the surgical team promptly after a fall if you landed on the operated side, the wound opened or began draining, pain or swelling increased, walking changed, or you are unsure whether the implant or surrounding bone may have been injured. A sudden inability to walk after hip replacement can be a sign of dislocation or another serious problem. Review MedlinePlus information on joint-replacement complications.
When a focused fall-risk evaluation helps
Extra assessment is useful after any recent fall or near-fall, or when there is dizziness, fear of walking, poor vision, neuropathy, weak balance, osteoporosis, multiple sedating medicines, cognitive change, a difficult home layout, or limited caregiver support. Physical or occupational therapy can assess transfers, device fit, stairs, and the actual home tasks that need modification.
If you are preparing for surgery or have had a near-fall during recovery, request a fall-prevention and joint-replacement planning consultation with Dr. Morton. Bring your medication list, mobility device, home layout concerns, and details of any fall. Emergency symptoms still require emergency care.
A practical fall-prevention checklist
Use your own discharge instructions first. Before surgery or discharge, confirm that the plan covers the places and times when you are most likely to be unsteady.
- Clear the route from the car to the bed, bathroom, kitchen, and usual chair
- Remove loose rugs, cords, clutter, pet toys, and unstable furniture
- Improve lighting and place a phone within reach of the bed and main chair
- Test bathroom equipment and transfers before the first unsupervised shower
- Use the prescribed walker or cane until the rehabilitation team agrees you are ready to progress
- Keep both hands available for the mobility aid and use a bag or basket for objects
- Stand in stages and pause if dizzy before taking a step
- Review medicines that cause drowsiness, confusion, blurred vision, or low blood pressure
- Wear secure nonslip footwear and plan separately for rain, sand, stairs, and uneven ground
- Know the emergency signs and how to reach the surgical team after a fall
Sources and further reading
- AAOS OrthoInfo: Home Safety Checklist
- AAHKS: Going Home After Knee Replacement Surgery
- CDC STEADI fall-prevention resources
- Scoping review: Falls and fear of falling in older adults with total joint arthroplasty
- Systematic review and meta-analysis: Risk factors for falls after hip or knee arthroplasty
- MedlinePlus: Getting your home ready for knee or hip surgery
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.