Why Does My Knee Replacement Hurt More At Night?

Knee Replacement Pain At Night

Pain after total knee replacement (TKR) is bad enough if its during the day and affecting your walking and movement.  Its a whole other level of problem when the pain at night increases when you’re trying to sleep and you simply can’t get comfortable.

total knee replacement night pain

In my home care practice, a common question from my knee replacement clients is ‘Why is my knee replacement pain at night worse?’  Sleep is extremely important for healing after a major surgery and the lack of rest can cause a delay in recovery.

So why does it seem like there is more throbbing knee pain at night after replacement?  Is there really more pain at night or is there something else going on that makes it feel like your knee hurts more?  Be assured that you’re not going crazy and indeed your pain can be worse at night.

Knee replacement pain at night often increases for a few reasons.  First, your walking and physical therapy during the day increases swelling and muscle lactic acid buildup causing pain at night.  Also, new knee replacements prefer movement and when the leg is at rest at night this causes discomfort and increased pain.

Leg Pain At Night After Total Knee Replacement

Not only can your knee be more painful at night but also the entire leg from hip to toe can be bothersome as well.  Remember, the knee is just one joint amongst the entire leg and does affect other parts including the foot, ankle, shin and hip regions.

Often times knee patients complain of mid thigh pain or even calf pain increasing at night.  These areas are muscular in nature and build up lactic acid easily causing increased pain once at rest.

Leg pain at night after knee replacement should not be of increased concern for you.  This is normal and part of everyone’s rehab process with a new knee replacement.

I will offer a few suggestions from experience that can help you with nighttime leg pain with your new knee.  This is assuming you are taking your prescribed pain medications for your knee from your surgeon.

First, be sure to elevate the leg for at least 1 hour above your heart level prior to sleeping  to decrease the swelling.  Second, ice your leg for 25-30 minutes heading into bedtime.  Finally, performing some gently ankle pumps while elevating should help drain the lactic acid and swelling from the leg.

Sleeping After Knee Replacement

One main problem in dealing with sleeping after knee replacement is the bed itself can be making the pain worse.  Beds are meant for supporting the entire body head to toe and maintaining that position throughout the night.

You might think about putting a pillow or towel roll under your knee to reduce knee replacement pain at night but then you think back to the hospital.  Most likely your surgeon told you ‘Do Not Put A Pillow Under Your Knee!’ when you get home.

The reason they do this is because getting your knee as straight as possible is THE most important goal early on.  In fact, you only have about 1 month to get your knee straight after surgery.  Placing a pillow directly under the knee forces a bent position which is opposite of what we’re trying to do.

Unfortunately beds can be too supportive not allowing the knee any wiggle room at night during rolling or movement.  When a bed is too firm, any slight knee movement can cause some strain to the knee and cause immediate pain.

Once your knee pain awakens you at night it can be very tough to get back to sleep.  Even with pain medications you can still be up for an extra hour or so with your pain.

So how do you best prepare for or hopefully avoid this night pain with your knee.  Trial and error is the best answer but there are a few things you should try for the best chance of sleep.

Placing a Pillow Under the ENTIRE Leg During Sleeping

The word ENTIRE is the important piece of this puzzle as far as using the pillow under the leg for sleeping.  You cannot just put the pillow under the knee but rather need to span the entire leg lengthwise.

Placing the pillow under the full leg keeps the knee fairly straight and is safe to use.  More importantly what it does is gives you leg some cushioning during sleeping which can lessen the discomfort in bed.

I would suggest that your pillow is fairly thin so that your leg does not try to roll off the pillow.  Memory foam does work great for this to shape form to your leg.

Sleeping in a Recliner After Knee Replacement Surgery 

You’ve probably heard this before but if not, sleeping in a recliner chair after a total knee replacement works best.  Yes, a recliner works better than any standard bed mattress for sleep after a TKR. 

recliner chair for knee replacement

Sleeping in a recliner is a common solution to the sleeping limitation once your knee is replaced.  I would recommended double checking with your surgeon on whether or not you can sleep in a recliner chair.  From my experience the answer is almost always ‘Yes’. 

Also make sure that there is an easy access to a manual pull handle or electronic up and down buttons to assist in returning to the seated position.  Some older model recliners require you to push backwards with good force in order to return to the seated positions.  For these older model recliners I would recommend avoiding using a recliner.

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

Why does this work so well for your knee replacement pain at night?  The answer is that in bed when you are lying flat there is no wiggle room for movement during the night.  If you happen to move body positions in bed even slightly, your entire body will likely move and often times there will be some pain and now you’re wide awake. 

The recliner chair allows you to separate movement in your torso and maintain a quiet lower body.  When you wake up and move your arm to scratch an itch, falling back to sleep will be easier.  In addition, your legs will be slightly elevated in many recliners allowing your legs to maintain above your head and torso. 

What this does is help to reduce the swelling in your leg and provide improved comfort at rest.  Swelling of the surgery leg can be a big hinderance to movement and comfort so a recliner does provide some additional help with this issue.

As to how long you should consider sleeping in a recliner after surgery, a solid 2 weeks would be the best timeframe.  Of course this will vary from person to person. Based on my experience you will get much more consistent sleep in a recliner. Your sleep pattern will be affected negatively by returning to bed too early.

Final Thoughts on Why Does My Knee Replacement Hurt More At Night

  • Walking and Exercise Causes Pain and Swelling for Worse Pain At End of Day
  • Lactic Acid Buildup During Day Causing Delayed Knee Replacement Pain at Night
  • New Knee Replacements Feel Better With Movement So Rest at Night = Pain Increase
  • Using Pillow Under Entire Leg Can Help Leg Pain At Night
  • Using Recliner Chair For Sleeping Can Work Better Than Bed At Night
About Jeffrey Roth MPT

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


What is The Best Pain Killer After a Knee Replacement?

The Truth About Knee Replacement Surgery (In 2022)