Balance after a hip or knee replacement

Written by the SOS Clinic physiotherapy team.

After a hip or knee replacement, most people focus on pain, bending and walking. Balance is easy to forget. Yet many people feel a little unsteady for months, and falls are more common in the first year than many expect.

The good news is that balance can be trained, tested and improved, alongside the rest of your rehab.

Why balance can be affected

Good balance needs strong muscles, steady joints and clear signals from the joint to the brain. Arthritis affects all of these, often for years before surgery. After the operation, swelling, pain and weak muscles can make things harder again for a while.

Walking aids, pain medicine and tiredness can also play a part. Many people have simply got used to favouring one leg, and it takes practice to trust the new joint.

How common are falls?

Falls after hip and knee replacement are common. A review of risk factors found that falls after going home were linked with things like certain medicines, living alone, being female and having fallen before.¹

An Australian study followed older adults for a year after hip replacement. More than four in ten had at least one fall, even though most had a low falls risk before surgery. Many of those falls caused an injury.² The authors recommended that rehab after hip replacement should include falls prevention.²

Does balance training help?

The research gives a mixed picture. One recent review found that adding balance and proprioception exercises to usual rehab improved balance and self reported function in the short term.³ The quality of evidence was low to moderate, and effects on other outcomes were not consistent.³

Another review compared balance training with standard rehab and found little difference for most outcomes, including walking speed, strength and pain.⁴ Those authors concluded that balance training was not better than standard rehab on its own.⁴

Balance exercises seem to help most as one part of a full program that also builds strength, walking and confidence. Standard rehab already includes some balance work, which may explain why adding more does not always show a big difference in trials.

What balance training looks like

Exercises are matched to your stage of recovery and your surgeon’s advice. They often progress like this.

• Standing with support. Standing with feet together, then one foot in front of the other, holding a bench.
• Less support. The same positions with light fingertip support, then hands free.
• Single leg standing. Standing on one leg, building up the time on the operated side.
• Moving balance. Stepping in different directions, turning, walking with head turns and stepping over objects.
• Harder surfaces. Standing on a cushion or foam, once your physiotherapist feels you are ready.

Leg strength work, especially for the thigh and side hip muscles, supports all of this.

How balance is tested at SOS Clinic

At SOS Clinic, balance can be measured on ForceDecks force plates. You stand on two plates, either on both feet or on one leg, sometimes with your eyes open and then closed. The plates measure how much your body sways and how evenly you share your weight between the legs.

The results show how steady you are on the operated side compared with the other side. Repeating the test over time shows whether your balance is improving. Your physiotherapist uses this, along with how you walk and move, to adjust your exercises. There is no single score that clears you, and the test is one part of a wider assessment.

Lowering your risk of a fall at home

• Keep walkways clear and remove loose rugs.
• Use night lights between the bedroom and the bathroom.
• Use your walking aid for as long as your physiotherapist or surgeon advises.
• Wear firm, well fitting shoes with a good grip.
• Ask your GP or pharmacist to review medicines that may make you drowsy or dizzy.

How SOS Clinic can help

The physiotherapists at SOS Clinic in East Melbourne see people after hip and knee replacement by any surgeon. They work within your surgeon’s plan and precautions, and can include balance testing and training in your rehab.

A biomechanical profile assessment uses VALD equipment to measure balance, strength and movement, so you can see your progress in numbers.

Prof Phong Tran, an orthopaedic surgeon who consults from the same clinic, performs hip and knee replacement. Read about anterior hip replacement or subvastus knee replacement with Prof Phong Tran.

When to get help sooner

If you have a fall after your surgery, tell your surgeon, even if you feel fine. Seek urgent care if after a fall you cannot put weight on your leg, the leg looks shorter or turned, you have new severe pain, or you hit your head. Get help promptly if you feel dizzy or faint, your calf becomes swollen and painful, or you have chest pain or trouble breathing. During opening hours, contact the clinic. After hours and on weekends, go to your nearest emergency department.

Book a balance and rehab assessment at SOS Clinic

Frequently asked questions

Is it normal to feel unsteady after a knee or hip replacement?

Yes. Many people feel unsteady for a while. Balance usually improves as strength and confidence return, and it improves faster with practice.

When can I start balance exercises?

Simple supported standing balance often starts early. Harder exercises come later. Follow your surgeon’s advice and your physiotherapist’s guidance.

I fell before my surgery. Am I at higher risk now?

Research suggests a past fall is linked with a higher chance of falling after surgery. Tell your physiotherapist so balance work can be part of your program from the start.

Can I do balance exercises at home?

Yes. Most balance work can be done at home, next to a kitchen bench or a sturdy chair. Your physiotherapist will show you safe exercises and how to progress them.

Do I need a referral to see a physiotherapist?

No. You can book directly. If you have a GP management plan, Medicare may cover part of the cost of a limited number of visits.

References

1. Lo CWT, Tsang WWN, Yan CH, Lord SR, Hill KD, Wong AYL. Risk factors for falls in patients with total hip arthroplasty and total knee arthroplasty: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2019;27(7):979-993.
2. Hill AM, Ross-Adjie G, McPhail SM, Jacques A, Bulsara M, Cranfield A, Etherton-Beer C, Azlan NR, Powell SJ, Hardisty G, Monterosso L. Incidence and associated risk factors for falls in older adults postdischarge who undergo elective total hip replacement surgery-a prospective cohort study. J Gerontol A Biol Sci Med Sci. 2021;76(10):1814-1820.
3. Domínguez-Navarro F, Hernández-Guillén D, García-Gomariz C, Díaz-Díaz B, Roig Casasús S, Pérez-Maletzki J, Maria Blasco J. Immediate effects on balance, self-reported, and health status for balance and proprioceptive training in patients undergoing total knee or hip replacement: a systematic review with meta-analysis. Disabil Rehabil. 2025;48(6):1513-1531.
4. Qu H, Zhen Q, Li H, Jiang Q, Cao X, Zhang L, Huang L, Dou H. Effects of balance and proprioceptive training on rehabilitation after total knee and total hip replacement: a systematic review and meta-analysis. J Aging Phys Act. 2025;34(1):82-90.