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Sleeping Concerns after a Total Knee Replacement

It seems to be a common consensus that patients have difficulty sleeping after undergoing a total knee replacement (tkr). I have received comments from some readers, and I can attest to the concern myself.

I mentioned in an earlier blog post, that I had a damaged nerve alongside my knee that causes problems. The damaged nerve is the result of bone spurs forming on each side of my damaged knee.

Well, that nerve problem results in my not getting a good night’s sleep. Irregardless of the position I am in, I awake experiencing pain from this. Luckily, the pain does not last. However, when it’s there…..it’s there. It’s sharp and quick.

Upon standing up from a prone position, I must wait a moment until my knee and body align. I find that the nerve pain diminishes when I bend my torso to the right. Experimentation is always underway. 🙂

I am not complaining, just stating a fact. My situation could be much worse and I am grateful it only involves a disruption of my sleep patterns.

Hope this helps others going through the same situation.

41 Responses

  1. I am 5 weeks post op from my TKR. I’m not sure where my progress is in comparision to others because everyone in the medical field says “everyone is different”…duh. The most annoying of all of this is my lack of being able to sleep through the night…it’s horrible. I am still on oxy due to the fact the pain is so powerful and I cannot find a comfortable position. (the pillow between the legs seems to be the best). I am somewhat relieved to read others are going through the same as I thought I was losing it (and I don’t have far to go as it is!).
    Otherwise, PT 3x a week, exhausting but extremely helpful. 100 degrees of flexion…my doctor would like 110 by next week! Grrrr…
    Good luck to all!

  2. I am 6 weeks post op from my TKR and having trouble with positioning and sleeping. Have not had a good night’s sleep in 3 weeks. Also having trouble sitting with legs dependent. I get severe pain behind knee/low thigh followed by numbness in foot. I was glad to read that this (sleeping problem) is common. Any suggestions to relieve the problem?

  3. Hi Debbie & Alice,
    I know the problems of sleeping after a tkr. Two nights ago (10 months after my surgery) was the first night that I enjoyed a full, uninterrupted night of sleep. Usually, there’s pain to contend with.

    I couldn’t sleep on my side for at least 3 months after surgery without serious discomfort. I find elevating my leg onto a pillow at night helps.

    I find an exercise that works for me regarding behind the knee pain is a stretching one. I sit in a chair, extend my leg onto another chair, and place a weight onto my knee. Start with just two pounds. This is painful at first, but eventually the pain will subside.

    Good luck to you both!

  4. Sleeping….what’s that. Out of surgery I couldnt sleep because of all the meds. 3 weeks after surgery I finally took a mild sleeping pill and got some sleep. Lately I go to bed and think about how soft my pillow is and how warm and comfortable my bed is and I drift off to sleep. Dont go to bed thinking you wont sleep. The mind is very powerful.

  5. I am 45 years old and four weeks post op (TKR) and I too am not sure where I should be. A sports injury at 15 years old lead to surgery then and have had many problems over the last thirty years and felt after many other things tried that this was my last resort. I have severe pain during and after therapy. I can’t put much weight on it after therapy for the rest of the day. The next morning it is fine. I only have an 80 degree bend right now and still walking with a cane. I don’t use it much around the house but do when I go out for safety. I am bearing full weight without a problem unless right after therapy. My biggest problem at this time is bending my leg as well as some very sharp pain that shoots down my shin at times. It doesn’t last long but is very intense. Others I know that have had this surgery have done much better than I so I am beginning to get very frustrated at my progress. I do my therapy everyday as well as going to the gym for water therapy. I still have some severe pain at times and my doc says to take advil that doesn’t touch the pain. I am sleeping well with the help of a pillow between my legs as I am a side sleeper. I don’t know why I am so behind. My therapist feels I may need munipulation under anesthesia to get better bend but I form scar tissue very quickly and am not sure if it will work for long. . I don’t know!! Any one else having these problems four weeks post op? Am I just expecting to much of myself? I saw my family doctor today for my annual checkup and he was surprised I wasn’t doing better so this didn’t help my frustration level. What am I doing wrong? Don’t get me wrong I am much better now than two weeks ago and grateful for that. Will this improve with time?

  6. Hi Alisa,
    Your situation sounds almost like mine at 4 weeks post tkr. My tkr is the result of an auto accident 30 years ago, so was trauma related. It wasn’t your typical tkr (aging).
    It doesn’t sound like you’re behind at all – to me, anyways.
    And, unless you’re not doing anything for your rehab – you’re not doing anything wrong.
    That’s my opinion, anyways.
    Good luck!

  7. I hit 5 weeks today and also can’t sleep unless I take an oxceydone which I am trying to stop using. reading this and other blogs I am convinced this is a 6 – 12 month recoop, too bad doc’s won’t share that info but I would have done tkr anyway.

  8. Okay, saw os today and I am scheduled for a manipulation under anesthesia in the morning. I am totally freaked out as he isn’t sure if he will be doing closed manipulation or opening me back up to extract the scar tissue by cutting it away. I am hoping it will be closed as I don’t want to have to heal from another incision again. That stinks!! He will try to manipulate without anymore cutting so I have my fingers crossed. I won’t be sleeping tonight that is for sure. I guess I can do that tomorrow!!

    I agree Tom, the Doc’s should share a bit more about the LONGGGGGG recovery period.

  9. For anyone else out there facing a manipulation and terrified as I was, well take a deep breath. It isn’t so bad and more importantly, IT WORKED!! I went from 62 degree bend to 100 degrees. Yes I was in pain when I awoke in recovery but meds helped with that and it isn’t like the initial surgery. It felt so good to have broken through that bricck wall where my leg wouldn’t bend. It is two days later and my Quad muscles are still a bit sore but I made my first full rounds on a bike today after five weeks of trying. Yesterday I was still rocking so don’t expect it to come in one day. The trick now is to retain it and I am certainly determined to do that. Now that the scar tissue is broken, I have to work on loosening the muscles and tendons that still feel short. I finally see the light at the end of the tunnel. So if you are facing a manipulation and searching the internet for answers, I hope this helps. It worked for me!!

    • Thank you Alisa so much for the words of encouragement. I am in my 8th week post op KNR and am facing the manual manipulation tomorrow morning. I too am scared to death of the pain as you probably well know. I just want the pain to go away. You are the only person who posted positive, encouraginbg words. Again, I really appreciate it and please pray for me tomorrow.

  10. Everyone is different. I am 48 and had my first TKR in August 2008. I thought I was slow, but then realized I had a a great physical therapist. She helped me through everything. I was at 110 after 3 weeks and then at 134 after 8 weeks. I finally started sleeping better in December when I had the second knee done. I am now 6 weeks out and have 139! I still don’t sleep. I’m lucky to get 3-4 hours of interrupted sleep per night. The doc said it could take 6-12 months to get through the sleeplessness. There is still a lot of pain. Just have to work through it.

  11. I’m happy to find this site! I had TKR a week before Xmas and am stuck at 90 degrees. Everything else seems fine strengthwise but just can’t bend it more. Feels like the outside and back part are blocked. Also having a terrible time sleeping. I get what feels like very strong muscle spasms in those areas which suddenly wake me up and I find myself yelling and scaring my poor husband. My PT feels the fibula part of the joint is getting stuck somehow because of the tight muscles. Massage seems to help somewhat but not enough.
    I just saw my surgeon and he feels manipulation while knocked out is the answer. I had previous surgery on that knee 30 yrs ago and he says that is partly to blame for more scar tissue. I am waiting to find out when that procedure will happen and hoping for good pain killers!

    • i had my knee done the week before thanksgiving – my flexion is only 90 degrees which it has been since the first week of december — i was manipulated 10 days ago that worked fine for about a week and now i am back at 90 — from day 1 i have had this horrible inthe back of my knee – really sharp – when i get in and out of the car i just want to scream — any time i flex my knee past the point of no return this is where my pain is thx

  12. Hi Leslie,
    Good luck with the pain meds…I never had any from those prescribed to me. 😦 I also have scar tissue from 30 years ago which is causing my knee not to bend like “normal”.

  13. I’m 3 months post TKR and it has improved my mobility significantly. ROM is about 125 degrees and I’m working out, getting stronger. I have days with no pain at all and some with minor hurting. It’s the nights that drive me crazy. I’ve not had a good sleep since surgery. It isn’t really what I’d call pain or hurting but more like the heebee-geebees. Once I’m settled in and all is quiet the wierd sensations come on. I can’t lie still and jsut have to move. It get so bad I just get up, take a Lortab, and move to another room–usually sit in the recliner until it subsides. Then I can sleep. OTC meds do nothing for this. Anyone else have these wierd sensations?

    • Hello everyone – I posted here awhile back, I had a tkr back in dec and in march was still stuck at 90 degrees. I finally had the manip done in May and immediately got to about 120. My doc predicted 140 and I am there now. I had heard very scary things about the manip, but it was fine and I am glad I trusted my doc. I still have some pain at the top of my fib when bending a certain way and what feels like muscle spasms but these are getting less frequent.
      It does indeed take a long time to recover, especially if you have already had an injury or surgery on the knee. And it takes a lot of work with physio too but I am very happy that I went through with this surgery.
      Wishing you all the best with your new knees!

    • yes i do …i have both knee in the last 8 week and i still can;t sleep

    • I’m one week post TKR and started PT today. She was amazed how good I was doing with my PT homework from the hospital. I think that’s the solution to getting “back on your feet” quicker. I stopped the pain meds after I got home because of how it made me feel, but haven’t slept over two hours the last three days. Tylendol PM didn’t faze the pain, just gave me night-mares and crazy thoughts. Will try other Rx’s until I find one that works and won’t keep me awake.
      Just think that the mane thing is to do what your PT and Dr. tells you to do. Sleep when you can and realize it’s just going to take time….Good luck you guys!!!

    • yes and I cant find a solution it is now 4.58 a.am. and have not been asleep since 10.p.m.sleep,g pills do not help looking for sugestions

    • I’ve experienced the insomnia phenomenon after TKA/TKR (07/21/10) and can’t attribute it solely to pain. I tend to sleep for short periods (1 hr max) and most often during the day (often while I’m on the CPM machine). Ambien has not really helped to achieve a more prolonged sleep pattern. It’s like my circadian rhythm has been altered by something. I refer to it as reverting to the ‘primitive brain’. Early man was required to have interrupted sleep because of safety concerns. I believe that this type of surgery (mobility-related) causes brain function to be altered.

  14. Hi everyone. I am 6 weeks out from tkr right. All seemed to be going well until 3 days ago. While at pt my quads kept contracting painful when strectching. That night my quads, and calf muscles took turns cramping up. The next day I got a pain down the outside of my leg. I guess it would be along the fibula area? So now when I stand up it hurts, and when sitting or lying I bend my knee, but, upon straightening my leg it hurts. Anyone have any ideas?
    I truely appreciate your answers.

  15. Hi all – it’s good to read of such similar experiences. I am now 9 weeks post-op and have this week returned to work. I have reached 110degrees bend of my tkr knee but feel since returning to work and spending more time in static behind the desk position that I’m losing some of that flex. I go to hydrotherapy twice a week but would like to go every day if I could. Exercising in warm water is such a pleasure. Sleeping? I’ve had problems all along – I am allergic to all opioid based medications so paracetamol has been it. When the paracetamol wears off in the early hours of the morning I wake up with the pain. I’m now beginning to wonder about the long term effects of taking maximum doses of paracetamol over a long period. Acupuncture has helped me heaps – I sleep like a baby for about three days after the treatment – wish I could afford to have that twice a week too! With the exercise bike – I tried at first with the seat up high so there wasn’t so much bend when the pedal comes up high. Didn’t really work because I was swaying the body too much to compensate for high seat. Then I tried pedalling backwards and just going back then forth. Now I can pedal on a manual zero pressure program for about 10 minutes max but afterwards the knee is very swollen. there has to be a balance between exercising and controlling the swelling. All in all, I am optimistic about the outcome and know that eventually the problems I’m experiencing now will resolve themselves, as long as I keep trying!!

    • I am 4 months post-op and on my last day of PT (after 12 weeks) my flexion was 118 degrees. I started using the the Stretch-Out-Strap in P.T. and still do every day in order to maintain flexibility. It is critical that you keep bending and stretching. Using this strap, you lie on your stomach with your foot hooked in the strap and bend your surgery leg toward your shoulder. It has worked wonders for me, you might want to ask your Physical Therapist or Ortho Surgeon about. I found mine on Amazon.

  16. I just had a total knee replacement where they even took part of my femur out and conected it with the knee replacement. I cant sleep when i try I get this feeling of excitment and restlesness over me it sucks i try to take tylonal pm but about 1 to 2 am i take my oxy. I am afraid becoming aditted to them so what can i do to sleep. I really dont have pain so it feels like im useing them just to fall asleep. I just started my pt and reading all this kinda dissapoints me but now that i think of it my first knee surgery it took me a while to get back in the swing of things but my tumor came back and this is like a whole knew ball game

  17. I had TKR exactly four months ago. I did PT 3x weekly for the first 12 weeks and now go to the gym 5x weekly. I still have significant knee pain daily and some swelling. Have not had a full night’s sleep since the night of surgery when I was pumped full of drugs. I had a severe reaction to Oxy and pretty much take OTC when I need pain relief and prescription anti inflammatory. I am currently having intermittent pain in my calf, hip and quad all on the surgery side. Dr believes I have a pinched nerve in the back. Other than the pinched nerve, my recovery has been better than expected presumably because I exercise quite a lot and keep my weight down. So, just encouraging everyone to exercise as much as you can when you are given the go ahead. All the best in 2010!

  18. i have the first TKR two months ago in my left knee , and the second one one month ago in the right one….i find very hard to sleep…i feel in my legs thousand hans go up and down , i wish i can find the way to sleep…….my knee bending over 120 , i do a lot bike….the only problem is the sleep , driving me crazy

    • I am 8 weeks following TKR and have 135 range of motion and no pain, BUT for some reason I can’t go to sleep at night. I am restless and toss and turn. This lack of sleep is wearing me down. Is this similar to your experineces?

  19. Hi I had knee replacement 5 weeks ago after a motorcycle accedent. I cant bend my leg at all. and the pain is hell. i sleep 1 hour a night. Now in cloudy all day. can anyone advise. thanks

  20. Jacques,
    If at five weeks you cannot bend at all you should probably see your ortho surgeon or physical therapist. I realize each patient is different but I would probably be a bit concerned. I’m sorry to say that lack of sleep is par for the course and you will eventually start to sleep more. You might also check in with your doc about that as well. Melatonin helps me relax at night and can be bought OTC. I’m about 4.5 months post op and still do not sleep the entire night. I can stay asleep about 4 hours, go to the bathroom and sleep another 2. So I guess that’s pretty good. But do check in with your doc about not being able to bend at all. Are you going to P.T.?

  21. Hi. They said I should only start PT at the end of the month. makes me worry a bit, Im getting so fustrated. I’m in South Africa so things are a bit slow with getting medical info. I am going to call the doc today to find out about whats going on. thanks for the help. I have a brace on my leg with sittings to bend. but its still set to 0

  22. I believe that in the States the common procedure is to begin P.T. almost immediately. Best of luck to you.

  23. Hi Jacques,
    I know in my case, I had an on-staff PT lady helping me the day after my tkr (in the hospital). I was using a walker and walking the hallway.
    I also did ankle pumps while laying down to prevent blood clots.
    Good luck and keep in touch!
    BTW…I tried reaching you via email, but it was returned.

  24. i just back to work.but work need to stand and walking .as i no TKR left knee ..for 3mth .because i work night shift one factory

    • Hi Rose,
      Thanks for visiting here and leaving your comment. Bless your heart for working the night factory shift after only three months post-tkr. That’s more than I could have done.
      Keep in touch and good luck!

  25. dude, i have just gone through orthoscopic surgery and im on my 3rd week of recovery an it is 3am i i cant f…ing sleep!!! it kill me !!!!!!!

  26. Because i working night shift .in morning when came back from work .first i bath take breakfast than little bit exerisce on tkr lelf leg taken half -hour .than i go tried to sleep for 5 hour

  27. Hello all,
    I had just my knee cap replaced Feb 19th & can only get it to 68 degrees… They said if I can’t get it to 90 degrees by April 14th they are going to do the manipulation… I’m so scared of this but it’s so painful trying to get your knee bent when it doesn’t want to go any further…. I’m constantly working it & go to PT three times a week but it’s like I’m hitting a wall. I feel like I’m taking way too much pain medicine but can’t tolerate it without it. I feel a little better knowing some of you have had the manipulation done & it’s helped. Good luck to all of you!

    • Wow I never heard of just getting a kneecap replaced. My kneecap was a problem and they said I needed a total knee replacement. What did they replace it with? Just curious, if you care to explain. Hope you get to that 90 degreees soon. Keep working at it and don’t worry about the pain meds, you need them now. And if you need the manipulation, it will help too. take care and good luck

      • Hi Sharon,
        This is a new procedure called Mako Plasty & is suppose to be less invasive than a total knee replacement. They took out my old knee cap & replaced it with plastic & metal.
        I’m still only at 77 degrees after six weeks & have til next Wednesday to get it to 90 degrees otherwise they are going to do the manipulation. I’m still having allot of pain. It just feels like there is some type of rubber band on my knee stopping me from bending it any further. It’s aggravating because there are people who have had a TKR & are at 110 degrees & they had there surgery after me.
        Thanks for responding & take care!

  28. Hi Nicole
    I had surgery April 5th 2010 and am going to PT but can’t bend my
    Knee past 90 degrees. My Dr is going to do manipulation
    After 3 more weeks if I can’t bend my knee. I’m
    Also upset that other people can bend. I just hope
    for the best

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