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Hip and Knee Care Library

Your source for articles written and reviewed by AAHKS member surgeons

Getting a Good Night’s Sleep after Hip or Knee Replacement Surgery

One of the most common complaints after total joint replacement is difficulty sleeping. The most common cause of sleep disruption is pain. It has been reported that more than half of patients wake up with pain after joint replacement. Many factors can affect the quality of sleep after a major surgery including anesthesia-type, narcotic use and discomfort due to pain or restricted leg movements.

As sleep is crucial to the recovery process, it is important to follow appropriate pain management protocols.

Contemporary pain management protocols are designed to be multifaceted and inhibit pain in a multitude of ways. Many protocols use a variety of injections and nerve blocks for localized pain, as well as employing narcotics and anti-inflammatory medication for several weeks after surgery. As such, pain protocols should be fully followed to ensure an adequate recovery.

Usually around the second or third week after surgery, you will start to increase your activity levels while at the same time decrease your narcotic use. This often coincides with having a difficult time sleeping. When this occurs, you should take your pain medication an hour before bed to achieve better comfort and help restore your sleep cycle. A few days off from strenuous activity or physical therapy will not inhibit your recovery, but can have a tremendous effect on your ability to fall asleep and stay asleep.

Overall, sleep deprivation after total joint replacement is manageable through pain management, the occasional use of sleeping pills, and activity modification. If all else fails, it is advisable to  call your surgeonwho can help you manage sleep disturbances during the postoperative period.


  1. Rosenberg-Adamsen S, Kehlet H, Dodds C, Rosenberg J. Postoperative sleep disturbance: mechanisms and clinical implications.  Br J Anaesth.1996;76:552-559.
  2. Wylde V, Rooker J, Halliday L, et al. Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthopaedics & Traumatology: Surgery & Research. 2011;7:139-44.
  3. Myoji Y, Fujita K, Mawatari M et al. Changes in sleep-wake rhythms, subjective sleep quality and pain among patients undergoing total hip arthroplasty. Int J Nurs Pract. 2014 Apr 30. doi: 10.1111/ijn.12345. [Epub ahead of print]
  4. Krenk L, Jennum P, Kehlet H. Sleep disturbances after fast-track hip and knee arthroplasty. Brit Journ of Anesthesia. 2012; 109:769-75.

This article has been written and peer reviewed by the AAHKS Patient and Public Relations Committee and the AAHKS Evidence Based Medicine Committee. Links to these pages or content used from the articles must be given proper citation to the American Association of Hip and Knee Surgeons.