Getting down onto the floor after a total knee replacement (TKR) is an important functional movement for reclaiming full independence, whether for retrieving a dropped item or engaging with children or pets. This action requires a specific, controlled technique to protect the newly implanted joint and the surrounding soft tissues during the early phase of recovery. Before attempting any floor transfers, you must first receive clearance from your physical therapist or orthopedic surgeon, as recovery timelines differ among patients. Mastering this movement relies heavily on proper weight distribution, core engagement, and using external support, since the range of motion in the operated knee may be temporarily limited and sensitive to direct pressure.
Necessary Preparations and Safety Checks
Prior to initiating the movement, check the environment to prevent falls and ensure stability. The area of the floor should be clear of obstructions, dry, and non-slip, perhaps covered by a stable, non-bunching rug or mat for cushioning. Locating a sturdy, fixed object, such as a heavy counter, a wall, or a solid piece of furniture, is important, as this support provides the necessary leverage for both the descent and the ascent.
Wearing appropriate footwear is also important, meaning shoes or socks with non-slip treads that securely grip the floor surface. If you are practicing this for the first time, having a partner or helper nearby can provide added security and confidence. You should also consider placing a soft pad or folded towel on the floor where your non-operated knee will rest to minimize discomfort.
Step-by-Step Technique for Getting Down
Begin by positioning yourself next to your chosen stable support, standing with your feet hip-width apart and placing one hand securely on the support for balance. The guiding principle for this maneuver is to place the majority of your body weight through the non-operated leg and your arms, keeping the operated leg protected. Step backward with your non-operated leg into a controlled half-kneeling or lunge position.
As you lower your body, allow the non-operated knee to gently touch the floor first, maintaining your weight through the front foot and your arm support. The operated leg should remain extended in front of you, preventing pressure or twisting on the new joint. From this half-kneeling position, shift your weight sideways, using your hands on the floor or support to guide your body down until you are seated on your hip or buttocks. The final seated position should allow the operated leg to be comfortably extended or bent within its current range of motion limits, avoiding forced flexion.
Step-by-Step Technique for Getting Up
Rising from the floor is more challenging than the descent, demanding greater upper body and non-operated leg strength for leverage. To begin the ascent, maneuver yourself into a position where you are on all fours, or if range of motion permits, move into a half-kneeling stance with the non-operated knee on the floor. Scoot yourself as close as possible to the stable support, ensuring you can grip it firmly with both hands or at least one hand and a forearm.
Initial Lift to Half-Kneeling
Pushing primarily with your arms and your non-operated leg, slowly shift your weight forward and upward toward the support, avoiding sudden jerking movements. Bring the foot of your non-operated leg forward, planting it firmly on the floor so that it is positioned directly under your hip for maximum power. Use the strength in your arms to push yourself up into the half-kneeling position, keeping the operated leg extended or lightly touching the floor in front of you to prevent weight-bearing.
Final Ascent to Standing
Once stable in the half-kneeling position, concentrate on driving through the heel of your non-operated, planted foot, maintaining a straight back and leaning slightly forward over the planted knee. As you rise, the operated leg comes forward to meet the non-operated leg. The primary force should continue to be generated by the push from the non-operated leg and the pull from your arms on the stable support. Rise slowly to a full standing position, pausing at each stage to regain balance and control before fully releasing your grip on the support.
Modifications and When to Avoid the Movement
Modifications for Safety and Comfort
Modifications can improve the safety and comfort of floor transfers, such as using specialized knee pads or a thick cushion to protect the non-operated knee from hard flooring. For retrieving items, a long-handled grabber tool is an alternative that allows you to pick up objects without needing to get down on the floor. Practicing near a bed or a low sofa provides a slightly elevated and softer surface to work toward, making the movement less of a drop and the ascent less of a struggle.
When to Avoid Floor Transfers
This movement must be avoided if you are experiencing acute, sharp pain in the operated knee, or if the joint is visibly swollen or unstable. If you feel dizzy, lightheaded, or unwell, the risk of falling is higher, and the movement should be postponed. Do not attempt this maneuver when you are alone and have not successfully practiced the technique with a physical therapist or a trained spotter, as the consequences of an unassisted fall can be severe.