Hi @connie1559 – I just had a left TKR on 1/29/19 (my right one was April 2017). Both times they were adamant about not putting any support under the knee – pillow, wedge, anything. The reason as @ellerbracke stated is extension – it is difficult to get the extension back and supporting the knee from underneath impedes the progress. I'm sorry to hear about the pain you are having. I wake up when its time for my pain medicine, but once I take it, I go back to sleep. Are you having trouble getting back to sleep after your meds?