Somewhere in the hallway of nearly every orthopedic floor in Massachusetts there is a practice staircase. Three steps up, a small platform, three steps down. A handrail on both sides. Good lighting. A physical therapist standing right there. Most people clear it on the second try and everyone in the room feels better.

Then you go home to fourteen steps with a turn at the top, a rail on one side only, and that rail is on the wrong side.

The practice stair is not a trick and the therapists are not cutting corners. It teaches the technique, which is the hard part and which most people genuinely learn. What it cannot teach is your staircase. This is about closing that gap in the two days you usually have.

The rule, and the reason behind it

The American Academy of Orthopaedic Surgeons puts it in five words in its hip replacement recovery guide: up with the good, down with the bad. Lead up the stairs with the good leg. Lead down the stairs with the operated leg.



Families reverse this constantly, usually out of what feels like common sense: protect the bad leg, so send the good one down first. That instinct is exactly backwards and it is why people fall on the way down rather than the way up.



Think about which leg is doing the work. Going up, the leg on the higher step lifts the whole body weight. That has to be the strong one. Going down, the leg still on the upper step is not stepping at all, it is lowering the body under control like a brake. That is the harder job, and it also has to be the strong one. So the operated leg reaches down to the lower tread while the good leg holds and lowers from above. In both directions the good leg is doing the load. That is the entire logic.



AAOS adds two things worth repeating. Use a handrail for balance. And expect one step at a time at first, both feet meeting on each tread, not foot over foot. Foot over foot comes back later, when strength does.

Two questions to ask before discharge that almost nobody asks

What is the weight bearing status, in writing?



This single line changes everything about how a person gets up a staircase, and it is usually buried in the discharge packet in abbreviations nobody explains. Weight bearing as tolerated means put as much weight through the leg as comfort allows, which is where most routine knee and hip replacements land. Partial weight bearing means a specified fraction only. Toe touch means the foot rests on the floor for balance and carries essentially nothing. Non weight bearing means the foot does not touch the floor at all.



A person who is weight bearing as tolerated can usually climb a staircase with a rail, a technique and a spotter. A person who is non weight bearing on one leg is doing something closer to a controlled hop up fourteen steps, which is not a thing to attempt in a stairwell with one family member. Ask for the status, ask them to write it down, and take it seriously. It also changes over the following weeks, so ask again at the first follow up.

For a hip, which surgical approach was used?

This matters more than families realize and it is rarely explained. A posterior approach hip replacement traditionally comes with precautions: do not bend the hip past ninety degrees, do not cross the legs past the midline, do not rotate the operated leg inward. Those restrictions have real consequences on a staircase, because a steep riser combined with a forward lean is exactly how a hip gets past ninety degrees without anyone noticing.



An anterior approach often comes with fewer or no movement restrictions, and many Massachusetts surgeons now use it routinely. Practice varies by surgeon, so the answer you need is not from the internet, it is from the person who did the operation. Ask what the approach was and ask what the precautions are, then write them on a card and stick it on the wall at the bottom of the stairs. Everyone helping needs to know, including the aide who arrives on Thursday.

The handrail is on the wrong side, and here is what to do



This is the most common problem we see and it is almost never mentioned before discharge. Most Massachusetts staircases have a rail on one side. Half the time that rail is on the same side as the operated leg going up, which means the person has to reach across their body to hold it, twist their trunk, and put the walker or crutch on the weak side. It feels wrong because it is wrong.



There are three real answers. Add a second rail, which a handyman can do in an afternoon on a straight run and which is by far the best long term fix. Go up backwards, which sounds alarming and is actually a standard technique for a short flight when it puts the rail in the right hand and the strong leg in the right place, but it should be taught by a therapist before anyone tries it at home. Or have a second person on the open side acting as the missing rail, which is what we usually do on the first few trips while a carpenter gets scheduled.



One more thing about rails in older homes. A lot of Massachusetts staircases have a beautiful original banister that is loose at the newel post. Grab it hard and it moves. Test every rail with your full weight before anyone leans on it, because the discovery you do not want is the one made at step eleven.

Set the house up so the staircase happens once a day, not six times



Every trip is a chance to fall. The single most effective thing you can do in the two days before discharge is reduce the number of trips, and that is a furniture problem more than a medical one.



• If there is a full or half bathroom on the main floor, move the bed down. A rented hospital bed in the dining room for three weeks beats a staircase four times a day, and no one has ever regretted it.
• If the only bathroom is upstairs, the bedroom stays upstairs. Do not split them. A person who sleeps downstairs and pees upstairs is climbing at three in the morning, alone, half awake, which is the worst set of conditions in this entire article.
• Put a charged phone, water, the walker and a light within reach of the bed, on the side the person will get out of.
• Clear the stairs completely. No baskets on the bottom step, no runner with a curled edge, no shoes. Tape down anything that moves.
• Light the top and the bottom. Plug in nightlights at both ends of the run, not the middle. People misjudge the last step far more often than the ones in the middle.

The stairs before the stairs



Families plan for the interior staircase and forget the trip from the car. In a Somerville or Dorchester triple decker there are usually four or five steps up from the sidewalk to the porch before the front door even opens. In Back Bay or the South End the stoop can be eight or ten. On the South Shore, homes raised for flood clearance in Quincy, Revere, Winthrop and Hull put another eight outside. In a split level in Woburn or Framingham there is a half flight the moment you are through the door.



These exterior steps are usually the hardest part of the day. They are often concrete or granite with no rail, they are shallower or deeper than interior treads so the rhythm is different, and in Massachusetts they are frozen five months a year. Count them before discharge day. If you are being discharged in February, salt them the night before, not the morning of.

When one family member is not enough



Be honest about this one, because the failure mode is predictable. A daughter helps her father up the stairs on day one, it goes fine, it goes fine again on day two, and on day four he catches a toe on a tread and she takes his full weight with no warning on a staircase where there is nowhere to put him down. Two people get hurt instead of one.



You want a second person if any of these are true. The person is significantly heavier than the helper. There is no usable handrail on at least one side. The staircase turns. The weight bearing status is anything other than as tolerated. The person is on medication that affects balance, which after orthopedic surgery is most people for the first week. Or the helper has their own back, knee or shoulder history, which after a certain age is most helpers.



A second trained person on the first few trips is not a permanent arrangement. Most families use us for the first week or two and then handle it themselves once the person is stronger and everyone has watched the technique done properly a few times. We would rather teach you and go away than come every day forever.

Questions families ask us

How soon after surgery can someone do stairs?



Usually the same day or the next, which surprises people. Clearing a short flight of stairs with a therapist is one of the standard things a hospital wants to see before it sends someone home, which is exactly why that practice staircase is in the hallway. If your relative has been discharged, they have almost certainly already done stairs once. The question is not whether they can, it is whether they can do yours.

What about crutches or a walker on the stairs?



A standard walker does not go up a staircase. The usual arrangement is a rail in one hand, a crutch or cane in the other, and a second walker waiting at the top so the person is not stranded on the landing with nothing to hold. Two walkers, one at each end, costs almost nothing and solves a problem families discover the hard way. Ask the therapist to walk you through the specific setup before discharge, because it depends on the rail and on the surgery.

What if they cannot do the stairs at all?



Then the staircase gets done seated, in a stair chair, by two trained operators, and the person does not use their legs at all. This is common after a complicated hip, after a fracture rather than a planned replacement, and any time someone is non weight bearing. It is also the right answer on the day of discharge even for people who will be climbing under their own power by the following week, because day one is not the day to find out.

Does insurance cover someone to help with stairs?



Home health physical therapy after a joint replacement is often covered and you should absolutely use it, but a home health PT visit is a scheduled therapy session, not a person who comes when you need to get down the stairs for an appointment. Those are different things and families are often told they have one when they need the other. Stair assistance from us is generally private pay and billed hourly. If the person has MassHealth Standard or CommonHealth and a permanent or chronic disability, ask about the Personal Care Attendant program at (800) 841-2900, and ask about PT-1 for rides to follow up appointments.

Call while you still have time to plan



The best version of this call happens the day the surgery gets scheduled, not the morning of discharge. That gives everyone time to add a rail, move a bed, count the outside steps and decide honestly whether one person can manage. Send us two photos, one from the bottom looking up and one from the top looking down, and we will tell you what we think even if you never book anything.



Care Remedy provides stair assistance, post surgery support and wheelchair transportation across eastern and central Massachusetts from offices in Woburn, Springfield and Brockton. Call 781-957-8076.



Stair technique guidance above follows the American Academy of Orthopaedic Surgeons total hip replacement recovery guide. This is general information and not medical advice. Your surgeon's instructions, your weight bearing status and your specific precautions always take priority over anything on this page.