Do you experience pain at night after your knee replacement surgery? Are you wondering how to sleep better with a total or partial knee replacement?
Are there positions to avoid or, on the opposite, to preference?
As a diagnostic radiographer I see so many knee replacement operations and hear patients ask these questions.
As usual I will rely on scientific medical studies and my own knowledge to answer your questions.
Happy reading!😀and feel free to ask questions in the comments or share your own experience.🙏
Last updated: June, 2025. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: Amazon affiliate links, full disclosure in the legal section.
| Food for thought After a knee replacement surgery, sleeping can be tricky due to pain, stiffness and potential discomfort from the new surgical position. It is very common for sleep to be disturbed in the first few weeks of your recovery and finding a comfortable a right position to sleep can be difficult but usually this improves with time. |
▶️Why does knee replacement hurt worse at night?
When you have had a knee replacement the surgery itself puts enough stress on the knee.
Pain after knee replacement is mostly inflammatory.it is a defence mechanism of your body that produces substances necessary for tissue healing which is damaged by the placement of the prosthesis.
These substances are brought to the treatment scar and knee tissue by body fluids. And these fluids accumulate more, causing pain and swelling.
Here are factors that may lead to increased inflammation often at night causing you pain.
⚫Reduced cortisol
When you sleep there is decreased natural anti-inflammatory hormone called cortisol which is naturally lower at night, potentially contributing to increased inflammation and pain.
⚫Stiffness due to inactivity at night because you are sleeping.
Staying still in one position while sleeping can cause the knee joint to stiffen, making it more painful.
⚫Pain perception and anxiety.
Your pain perception may change at night making pain seem more pronounced. I have seen patients feeling so stressed after a broken bone, worrying how long healing will take place. This alone can cause more pain as you sleep.
⚫Pain medication wearing off at night.
Pain medications may not last throughout the night, leading to increased pain in the early morning.
Studies done by Bartosiak 2022
⬛State that certain medication taken can sometimes be an impact on sleep.
⬛And if you had pre-existing sleep disorders such as apnoea syndrome before the operation, this can have a big impact on your sleep.
▶️Are there any prohibited sleeping positions to take at night with a knee replacement?
Some people I have seen often fear to rest on their knee thinking it will dislocate, be rest assured, your knee is solid it cannot dislocate after surgery
In the first weeks of your recovery, you may avoid problematic sleeping positions that may put pressure on your surgical site.
For example:
🔵Sleeping on your stomach can directly put pressure on the new knee. Causing you pain and discomfort.
🔵Sleeping on the side of the operated knee with a bent knee can put stress on the joint and cause pain.
🔵Putting a pillow directly under the operated knee may cause it to bend leading to extra stress on the joint replacement and pain.
There is no prohibited sleeping position after a knee replacement, but it is best to avoid any position that may cause or force your knee into a position that is not comfortable, hence hindering healing.
Try to be patient, the major recovery time after a knee replacement can take 3 to 6 weeks and several months to heal entirely.
Try to wait until 3 weeks or more to begin slowly testing and adopting to your normal sleeping positions, if they do not cause you pain then you can decide accordingly.
▶️Different positions you can try for sleeping with your knee replacement.
🔵Back sleeping
Most people I have seen, testify sleeping on their back after a knee replacement to be their preferred comfortable position.
They place a pillow lengthwise under the knee and calf. This keeps the leg straight and cushions the knee from pressure.
Position to limit in the days and weeks following knee surgery replacement.
Caution! Avoid placing a pillow directly under your foot because this will put stress on your knee and probably cause pain.
This position is hard to maintain for too long throughout the night, some people find it difficult to fully straighten the knee which ends up causing knee stiffness.
However, if you find only comfort in this position try to:
🔴Avoid it during the day.
🔴At night you can try other positions and adopt this position only if other positions do not work.
🔴Try to keep the volume of the pillow, to allow a less flexed knee.
Your leg should stay as straight as possible with proper support to avoid hyperextension of your knee. This helps to keep blood flowing to your surgery site.
▶️Sleeping on your side on the non-operated leg with a pillow in between your legs is ideal for some people.
This helps to cushion your knee and gives you comfort as you sleep. Remember to sleep on your non-affected leg. because sleeping on the operated side will put pressure on the surgery site.
This position is better than lying on your back because as you sleep you can easily extend your knee straight unconsciously.
However, some people find this position painful and sometimes they find it difficult to keep the leg straight enough.
As shown in the photo, you can use any pillow you have at home. Nursing pillows made of microbeads can also be very comfortable (see on Amazon), as well as small foam pillows that fit between the legs (see on Amazon)
Caution! Avoid moving around too much as you sleep, this can trigger pain in your knee.
▶️Why can’t you put a pillow under your knee after knee replacement?
Sometimes I have seen doctors suggesting a foam wedge for surgery patients to place under their legs to help elevate the leg while you sleep on your back.
Or using an adjustable bed that allows you to elevate your legs
However, when you have had a knee replacement you are supposed to keep your knee straight, but the wedge will keep your knee bent which is not bad for your recovery.
You may use two or more pillows on top of the wedge to keep your leg straight. This is ideal for short rest rather than sleeping at night.
Reason being when we sleep, we are more likely to change position during the night and your leg may fall off the pillow.
So, one of the reasons why you can not put a pillow under your surgery knee
🔴To avoid knee to bend, discomfort and pain.
🔴Limited range of motion.
Instead of putting a pillow under the knee you can elevate the leg using a pillow under the calf or heel, this can help reduce swelling and promote blood flow which can help in your recovery.
Feet elevated higher than the heart with a cushion. This slightly bends the knees, so it should be limited especially during the day to avoid knee stiffness.
▶️Other ways to relieve night time pain after knee replacement surgery.
Finding a more comfortable sleeping position is one way to relieve pain and sleep better with a knee replacement.
But anything that aims to help relieve knee pain can potentially improve your sleep as well!
🟠 Managing pain with medication.
After your knee replacement, normally your doctor will discharge you with medication to help you manage pain while healing.
It is advisable to take your pain medication one hour before bed to allow it to take effect, this will allow you to have a painless sleep.
🟠You can use ice tubes wrapped in a cloth and apply on your knee 15 to 20 minutes before bed.
This may help with swelling and easing pain before bed, never sleep with an ice pack on your knee, and do not apply it directly, not good for your skin.
🟠Make your room comfortable and cool dark.
It is easier to fall asleep in a dark cool room, as light can wake you up and cool temperatures can make you go to sleep easier.
Make sure your sleeping environment is suitable for your liking, it’s good for your health.
🟠Message your thigh or the sore parts of the leg.
Gentle massage can be beneficial after knee replacement, especially for thigh and leg discomfort.
Massage can help increase blood flow, improve circulation, reduce muscle tension, and aid in soft tissue recovery. It can also help improve mobility and flexibility in the affected area.
However, it’s crucial to consult with your surgeon or physical therapist before starting any massage therapy, as they can provide guidance on when and how to massage safely.
🟠Wear compression stockings
Wearing compression stockings after a knee replacement helps reduce swelling and the risk of blood clots in the legs. see on Amazon for different simples
They are typically recommended for a few weeks post-surgery, but the specific duration may vary depending on individual circumstances and your surgeon’s instructions
However, wearing compression stockings is usually not recommended at night but I have seen some people who find them more comfortable to wear while sleeping.
▶️ Whatever you do, you will sleep better at night over the following weeks of your knee recovery.
What do scientific studies say:
⚪Pain is more common after surgery and it can persist after the surgery, in fact, neuropathic pain is as high as 12.7% at 6 months after the surgery of a total knee replacement.
⚪Chronic pain after total knee replacement is reported to affect the quality of sleep even in Individuals with non-surgical chronic pain syndromes.
⚪More severe pain experience poorer sleep quality, delayed sleep onset, increased number of awakenings and fewer hours of sleep per night in the first month after the operation
Herrero-Sánchez,2024)
⚪Sleep disturbances postoperatively can lead to increased pain and decreased physical function after surgery (Purcell,2023)
⚪Some studies show that total knee replacement in some patients improves sleep quality. although some studies report disrupted sleep quality in the periods close to the surgery (Alipourian 2021)
⚪3 months after total knee replacement surgery, most people describe an improvement in their sleep (Mehmet 2014)
The bottom line:
Whatever you do, it is highly likely that your sleep will be better approximately one month to one and a half months after the operation. Better than before the surgery.
We have come to the end of this article, for any experience or questions please leave in the comments section.
Wishing you a quick recovery!🙋
🔵Why is there so much pain after a knee replacement.
🔵Recovery tips of knee replacement.
🔵Does kneeling damage knee replacement
🔵Swelling after total knee replacement
📚Sources:
Longo UG, Corradini A, Marchetti A, Di Sarno C, D’Angelo C, Arias C, De Marinis MG, de Sire A, Denaro V. I Am Afraid I Will Not Be Able to Walk, That Is What Worries Me-The Experience of Patients with Knee Osteoarthritis before Total Knee Arthroplasty: A Qualitative Study. J Clin Med. 2024 May 13;13(10):2878. doi: 10.3390/jcm13102878. PMID: 38792420; PMCID: PMC11122229.
Bartosiak K, Schwabe M, Lucey B, Lawrie C, Barrack R. Sleep Disturbances and Disorders in Patients with Knee Osteoarthritis and Total Knee Arthroplasty. J Bone Joint Surg Am. 2022 Nov 2;104(21):1946-1955. doi: 10.2106/JBJS.21.01448. Epub 2022 Aug 4. PMID: 35926180.
Herrero-Sánchez MD, García-Iñigo Mdel C, Nuño-Beato-Redondo BS, Fernández-de-Las-Peñas C, Alburquerque-Sendín F. Association between ongoing pain intensity, health-related quality of life, disability and quality of sleep in elderly people with total knee arthroplasty. Cien Saude Colet. 2014 Jun;19(6):1881-8. doi: 10.1590/1413-81232014196.04632013. PMID: 24897487.
Alipourian A, Farhadian N, Zereshki E, Khazaie H. Improvement of sleep quality 6 months after total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2021 May 28;16(1):342. doi: 10.1186/s13018-021-02493-4. PMID: 34049552; PMCID: PMC8161970.
Er MS, Altınel EC, Altınel L, Erten RA, Eroğlu M. An assessment of sleep quality in patients undergoing total knee arthroplasty before and after surgery. Acta Orthop Traumatol Turc. 2014;48(1):50-4. doi: 10.3944/AOTT.2014.3163. PMID: 24643100.
Purcell KF, Scarcella N, Chun D, Holland C, Stauffer TP, Bolognesi M, Lachiewicz P. Treating Sleep Disorders After Total Hip and Total Knee Arthroplasty. Orthop Clin North Am. 2023 Oct;54(4):397-405. doi: 10.1016/j.ocl.2023.05.008. Epub 2023 Jul 11. PMID: 37718079.