How to Sleep After Total Knee Replacement

Best Way To Sleep After Knee Replacement —

A major issue leading to my patients getting a knee replacement is the inability to sleep.  You assume your sleep pattern will improve immediately after your knee is replaced but unfortunately its not that simple.

how to sleep after total knee replacement

Sure you may get lucky but likely you will have some continued sleep issues in the initial phase.  Unfortunately this night pain after TKR is normal for this stage of your recovery but isn’t a long term issue of concern.  

Be sure to do all of the correct preparations before going to bed to ensure the most quality sleep.  This would include taking pain medications as prescribed by your surgeon as well as using ice before bed to reduce pain and swelling. 

I recommend you put ice on your knee for 25-30 minutes with a thin cover to protect the skin.  Be sure you do feel the cold from the ice at work or you will not get the pain and swelling reduction benefits you’re seeking.  

Your surgeon will have you sleep on your back for the first 4-6 weeks after knee replacement to make sure it gets straight.  Other sleeping considerations after knee replacement include using a recliner chair, placing 1-2 pillows under your entire surgery leg.

Can I Sleep on my Side After Knee Surgery?

The all important question of when one can return to sleeping on their side after surgery might not be what one would expect.  Most surgeons will want you to stay flat while sleeping for 6 weeks to allow proper healing. 

Don’t fret, most people have trouble sleeping after their knee replacement.  Good news is there is a solution for your back sleeping: using a recliner chair for sleep.

Sleeping in a Recliner After Knee Replacement Surgery

Sleeping in a recliner after knee replacement is a common solution to the side sleeping limitation after surgery.  I would recommended checking with your doctor on whether they allow you to sleep in a recliner chair. Good chance the answer is ‘Yes’. 

sleeping after knee replacement recliner

The only potential issue would be if your recliner seat is old and worn and not provide you with a proper support system for your knee. 

Please make sure that there is easy access to a manual pull handle or electronic up and down button to assist in returning to the seated.  Some older models make you push backwards with good force in order to return to the seated position.  For these older model recliners only I would recommend avoiding.

Why a Recliner Chair Helps with Sleep After Your Knee is Replaced

Why does a recliner work after TKR?  The answer is that in bed there is no wiggle room for movement during the night.  If you roll over or change positions in bed even slightly, your entire body will roll and cause sharp or throbbing knee pain making you awake and irritated. 

The recliner chair allows you to separate movement in your torso and maintain a quiet knee.  If you were to wake up, falling back to sleep will be easier.  In addition, your legs will be slightly elevated in most recliners allowing your knee to maintain above your head and upper body. 

This helps reduce the swelling in your replacement knee and provide improved comfort at rest.  Swelling of the surgery leg can be a limitation to movement and comfort so a recliner does provide some extra help with this issue.

How long you should be sleeping in a recliner after knee replacement? 2-3 weeks would be the best timeframe to start.  Based on my PT experience you will get much better sleep in a recliner. Your sleep pattern will be affected negatively by returning to bed too early.

Should I Buy A New Bed or Recliner Lift Chair Before Knee Replacement?

If you’re asking this question then you are likely already on your way to answering it.  New furniture isn’t cheap and would be a substantial investment.  That being said, it may be worth it to make your knee recovery easier in the short term. 

If you are looking into a recliner for your knee replacement you should consider a mechanical lift chair.  These recliners can bring you up into a fully standing position with zero effort on your part. 

Nice lift chair recliners cost $1000+ however some Medicare providers can assist you in reducing the cost. Medicare often times covers the cost of the power lift mechanism in the chair. 

Please check with your insurance provider or call Medicare directly if you are in that age bracket.  It all comes down to a personal financial decision of whether to upgrade your home setup. Purchasing a recliner is not a necessary piece of your knee recovery.

Other Sleeping Considerations After Knee Replacement

Lifting Leg in and Out of Bed After TKR

Because of the lack of early leg strength after knee replacement it can be difficult to lift your leg in and out of bed.  There are devices called leg lifters which have a long handle attached to a semi-flexible loop which can be placed around your foot to then lift up into bed with ease. 

If you don’t have a leg lifter an alternative is taking a belt or a long scarf and necktie. Forming a loop at one end using the same lifting concept as leg lifters can provide you extra support.  These lifting devices also help in keeping knee pain under control. This is due to the support they provide during normally painful side to side movements. 

You were likely taught in the hospital to use your other leg to hook underneath the surgery knee for support.   While this does work and can provide that extra support, I suggest to my patients that having their ‘good leg’ available for push off and balance is the safer choice. Using a leg lifter would be the best option.

A rule of thumb is you should get into bed on the side opposite of your surgery leg.  

If you had a right total knee replacement, go to the left side of the bed and sit as far towards the pillow as possible. Do this before lifting your leg into bed so you will be in position for sleep.  Remember, no rolling in bed.  

My Bed Is Really High.  How Can I Get My Knee Up Safely?

If you have a high bed, this height can be a big hurdle to overcome after surgery. For this setup it would first be suggested to use a leg lifter as described above.  Second, you will likely need some extra help from a friend or spouse to perform safely. 

Using a small step stool can be tricky especially if you are using a walker. Trying to step up on the stool pushing from your walker and coordinating can be difficult. 

The best thing you could obtain would be a longer step aerobics type stool. This would allow you to get both feet up on a steady safe platform.

While these are not as popular in the exercise world anymore they are readily available online. Good chance a neighbor or friend may have one in storage.

When Can I Sleep on my Stomach After Knee Replacement?

For those stomach sleepers you will normally get the same response from your surgeon. The range of 6 weeks until you can attempt retuning to this position is the norm. 

From my PT perspective this position would be less of a concern than side sleeping 

Can I Put a Pillow Under My Leg After My Knee Is Replaced?

It may also be worth a try to place a full pillow lengthwise under your knee for extra comfort. This pillow should be long enough to cross over the knee and support to the upper and lower leg regions. 

pillow under knee replacement

Placing a pillow only under your knee would not be allowed. You do need to keep the leg straight during sleeping to maintain quality blood flow and prevent clot or deep vein thrombosis (DVT) formation. 

 In other words, if your knee is not straight during sleeping then you need to adjust your position.

If you are in the early recovery phase still receiving home care, which would be highly suggested in your first few weeks home, make sure to discuss all things sleeping positions with your physical therapist and/or occupational therapist as they are well educated in this matter.  

If you are into the third or fourth months of knee recovery still having sleeping issues due to pain, a phone call or visit to the surgeon would be wise to make sure the knee is intact and safely set.  A successful knee replacement will eventually bring you many pain free restful nights.  

Final Thoughts on How to Sleep After Total Knee Replacement

  • Sleep flat on your back for the first 4-6 weeks after surgery
  • Sleeping on a recliner for the first few weeks after surgery is the best option
  • Using a pillow under your entire leg can give you pain relief
  • Timing your pain medications prior to bedtime can assist with sleep
About Jeffrey Roth MPT

Owner and operator of Roth Therapy Services in Pittsburgh, PA focusing on in home rehabilitation physical therapy services.


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