How to sleep after knee replacement surgery: tips for comfort and pain relief
Discover how to sleep more comfortably after knee replacement surgery, plus get pain relief tips from Hinge Health physical therapists.
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Quality sleep is essential for everyone — especially if you’re recovering from knee replacement surgery. “Sleep is a powerful part of the healing process,” says Christynne Helfrich, PT, DPT, a physical therapist at Hinge Health. “Quality rest can help ease discomfort and support your body as it heals.”
About half of people who get knee replacement surgery experience knee pain at night or have trouble finding a comfortable sleep position. This can lead to a challenging cycle — interrupted sleep can intensify discomfort and leave you feeling fatigued.
You can break this pain-sleep cycle and ease nighttime knee discomfort by adjusting your sleep position, adopting a sleep hygiene routine, and performing targeted exercises.
Read on for sleep tips and knee exercises recommended by our Hinge Health physical therapists that can help you improve your sleep and recovery from surgery.
Reviewed by our clinical and medical experts
Bijal Toprani, PT, DPT
Christynne Helfrich, PT, DPT
Causes of knee replacement pain at night
Many people experience nighttime knee pain and sleep problems before knee replacement surgery. After surgery, knee pain may worsen briefly (especially at night) due to post-op pain before getting better. One review found that many people experience poor sleep in the first month after knee replacement surgery. But research also shows that sleep quality usually improves by three months after surgery.
As your knee heals and you rebuild strength and mobility in the joint, knee pain in general and at night should subside. Here are the most common reasons your knee may hurt at night after surgery.
Post-op recovery. After knee replacement surgery, it’s completely normal to notice changes like bruising, swelling, stiffness, or soreness in your leg. During surgery, damaged cartilage and bone are removed and replaced with artificial pieces that now make up your new knee joint. These sensations are a part of your body’s natural healing process as you adjust to moving with your new joint.
Medication wearing off. As post-surgery pain medication begins to wear off, or as you reduce how much pain medicine you take, you may notice more discomfort.
Prime healing time. Even though you’re resting at night, your body is hard at work supporting your recovery. Your body undergoes inflammation, a sign of repair that’s often accompanied by swelling and discomfort during the night.
Uncomfortable sleep positions. Sleeping in a way that doesn’t support your body may put extra stress on your knee. “A lot of people can’t tolerate stomach sleeping after knee replacement surgery because it puts pressure on their incision,” says Dr. Helfrich.
Lack of movement during sleep. When you stay in one position for a long time while sleeping, it’s common to wake up with some stiffness or achiness around your knee as movement is what helps keep your joints moving smoothly.
Too much or too little activity during the day. Finding the right balance of activity during your recovery is important. If you don’t move much during the day, you might notice more pain at night, says Dr. Helfrich. Gentle movement helps promote blood flow to your knee, supporting healing and keeping swelling and stiffness at bay. On the other hand, doing more activity than your body is ready for — especially early on in your recovery — can lead to more discomfort.
No distractions. When you’re lying in bed at night with no distractions like screens, people, or tasks, you may be more aware of sensations like pain.
Best sleeping positions after knee replacement
There’s not just one best sleeping position, however, there are a few options that may be more comfortable than others. The best way for you to sleep after a knee replacement surgery will depend on your pain level and personal preferences. Try these tips to sleep comfortably after knee replacement surgery.
For back sleepers
Try lying on your back with your legs straight and calves and feet supported on pillows or cushions — a wedge pillow also works well. Just be sure to not place the pillows directly under your knees. “Elevating your legs can help reduce swelling and relieve knee stiffness,” Dr. Helfrich says. “This position also encourages your knee to find a natural, gently extended position, which can support comfort and flexibility as you recover.”
For side sleepers
If side sleeping feels most natural to you, it can still be a comfortable option during your recovery. To ease any pressure on your surgical knee, try lying on your other side so that your non-surgical knee is on the bed. You can place a pillow between your knees for additional support. “Try to keep your surgical leg as straight as it feels comfortable to support circulation as you rest,” Dr. Helfrich says.
For stomach sleepers
Stomach sleeping is generally not recommended after knee replacement surgery because it puts direct pressure on your surgery site. Try to avoid this sleeping position for the first four to six months after surgery, but confirm with your surgeon.
How to relieve nighttime pain after knee replacement
There are many strategies you can take to reduce nighttime knee pain and support recovery. These include:
Try physical therapy and targeted exercises. Targeted exercises can help strengthen the muscles around your knee so you get back to moving comfortably and rest easy at night. Research suggests doing exercises early on after knee replacement can shorten hospital stays and prevent complications. Discuss your physical therapy needs and plan with your surgeon. Alongside in-person PT, a program like Hinge Health can also help support your recovery.
Ice your knee before bed. Icing throughout the day can help ease inflammation. Icing also numbs nerve endings, which can reduce pain before sleep. Just make sure not to fall asleep with an ice pack on your knee, says Dr. Helfrich.
Consider pain medication as recommended by your healthcare provider. Both over-the-counter options — such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) — and prescription pain relievers may play a role in managing knee pain after total knee replacement. Always consult your healthcare provider or pharmacist to ensure any medication you take is safe for you, considering your medical history and current prescriptions.
Prioritize sleep hygiene. “Adopting good sleep hygiene habits, such as sticking with a regular sleep schedule, reading a relaxing book, and avoiding caffeine in the afternoon can help you get restful sleep,” says Dr. Helfrich. Other helpful sleep practices include limiting screen time before bed and keeping your room cool.
Get out of bed and move. If you’re having issues falling back asleep because of knee discomfort, taking a short walk around your room or down the hall can help. Movement boosts circulation, eases swelling, and helps combat joint stiffness. If you need to get up in the middle of the night, turn on a dim light so you can see clearly and move slowly.
Create a relaxation practice. There are many ways to relax before bed, such as doing deep breathing exercises and visualizing peaceful scenes. These relaxation techniques can also help you fall back asleep.
Stay active. Gentle movement during the day (such as walking and going from sit to stand) can support your comfort at night. When you exercise, your body releases natural pain-relieving chemicals called endorphins, says Dr. Helfrich. Performing targeted exercises that support your knee, such as knee extensions and calf raises, can help ease inflammation, keep your joint feeling smooth, and prevent stiffness that might disrupt your sleep. “The key is to find your movement sweet spot: Just enough to keep things moving, but not so much that you increase discomfort,” Dr. Helfrich says. Listen to your body and adjust as needed.
Exercises for knee replacement recovery
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- Straight leg raise
- Knee extension
- Hamstring curl
- Sit to stand
- Calf raises
These exercises can help you regain mobility and range of motion and rebuild strength in the quadriceps, hamstrings, and calves. “All of these muscles work together to support your knee,” says Dr. Helfrich. Doing these moves before bed can also help ease stiffness so you can sleep more comfortably. While these exercises are often recommended after surgery, it’s important to work closely with your surgeon and physical therapist throughout your recovery and consult your healthcare team before starting or changing your exercise routine.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Physical therapy (PT) is for more than just recovering from surgery or injury. It’s one of the top treatments for joint and muscle pain. It helps build strength, improve mobility, and reduce pain. And it doesn't always need to be in person.
Hinge Health members can conveniently access customized plans or chat with their care team at home or on the go — and experience an average 68% reduction in pain* within the first 12 weeks of their program. Learn more*.
Why avoid a pillow under your knee after surgery?
While it may feel comfortable to rest with a pillow under your knee, it’s best to avoid this position after knee replacement surgery. Keeping your knee bent for long periods can make it harder to fully straighten your leg later — and may contribute to stiffness and delayed recovery. “We recommend keeping your knee as straight as possible while you rest, to support better healing and comfort,” says Dr. Helfrich. If you sleep on your back, try placing pillows under your calf and foot to gently elevate your leg while keeping your knee straight.
PT tip: Take your time getting out of bed
Middle-of-the-night bathroom trips or walks to ease stiffness after a knee replacement can feel a bit tricky. “You might feel groggy from sleep, your knee could be stiff, or you may be a little dizzy from medications,” says Dr. Helfrich. Take your time and don’t rush. Make sure you use the assistive device recommended by your surgeon and keep it close to your bed. Set yourself up for success by clearing the space around your bed of belongings or area rugs before bed.
How Hinge Health can help you
If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.
Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
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References
1. Getting a Good Night’s Sleep After Knee Replacement Surgery - American Association of Hip and Knee Surgeons (AAHKS.) (2024, July 17). AAHKS. https://hipkneeinfo.org/knee-care/getting-a-good-nights-sleep-after-knee-replacement-surgery
2. Wylde, V., Rooker, J., Halliday, L., & Blom, A. (2011). Acute postoperative pain at rest after hip and knee arthroplasty: Severity, sensory qualities and impact on sleep. Orthopaedics & Traumatology: Surgery & Research, 97(2), 139–144. doi:10.1016/j.otsr.2010.12.003
3. Jacopo Antonino Vitale, Banfi, G., Viganò, M., & Negrini, F. (2023). How do patients sleep after orthopaedic surgery? Changes in objective sleep parameters and pain in hospitalized patients undergoing hip and knee arthroplasty. International Orthopaedics, 47(8), 1929–1938. doi:10.1007/s00264-023-05862-2
4. Bertram, W., Penfold, C., Glynn, J., Johnson, E., Burston, A., Rayment, D., Howells, N., White, S., Wylde, V., Gooberman-Hill, R., Blom, A., & Whale, K. (2024). REST: a preoperative tailored sleep intervention for patients undergoing total knee replacement – feasibility study for a randomised controlled trial. BMJ Open, 14(3), e078785–e078785. doi: 10.1136/bmjopen-2023-078785
5. Alipourian, A., Farhadian, N., Zereshki, E., & Khazaie, H. (2021). Improvement of sleep quality 6 months after total knee arthroplasty: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 16(1). doi:10.1186/s13018-021-02493-4
6. An assessment of sleep quality in patients undergoing total knee arthroplasty before and after surgery. (2020). Aott.org.tr. https://www.aott.org.tr/en/an-assessment-of-sleep-quality-in-patients-undergoing-total-knee-arthroplasty-before-and-after-surgery-134048