Trouble sleeping after TKR: What helped you sleep?

Posted by jackieboo1 @jackieboo1, Nov 2, 2018

I am a 60 year old woman 2 months post op from left knee replacement. I am having trouble sleeping. My knee feels like a square peg in a round hole. Tried pillow between legs, Tylenol and ice. Nothing seems to help.
Suggestions?

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@sueinmn

Hello and welcome to Mayo Connect. Sorry to hear that your sleep is being interrupted, but this is definitely a frequent complaint after joint surgery. We always want to believe we'll "bounce right back" but the truth is, joint surgery is a major assault on the body - bones, muscles, tendons, nerves and soft tissue are all involved. Each heals at its own pace, and each of us feels pain differently.

Two ways I found to ease pain after surgery are ice and Tylenol.
I used my Cryocuff ice machine close to 24 hours a dat for several weeks - even at night. And Tylenol extra strength on a regular schedule helped me stay ahead of the pain.
The other thing many people don't know is that the leg should be elevated whenever you are not "up and doing" - above the heart is best to keep swelling down and to keep the lymphatic fluids moving back toward the body (these carry away the by-products of healing), so add some pillows to the footrest, sofa and bed.
Have you been doing all of this already? If that is not enough, it may be time for a call to the doc for something a bit stronger, or a temporary sleep aid, to allow you to rest.
Sue

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Thank you. You’re so right about the “assault on the body”. I’m already doing the other things and find Tylenol just doesn’t do anything for the pain. Even the Dilaudid didn’t touch it. However, last night I came to the realization that the pain comes from all the areas of my leg & foot that are all bruised and black & blue post surgery (hence the “assault on the body”). The pain is severe, much worse than the surgical pain. I decided to rub Diclofenac 8% Ointment that I had on hand into the area to c if that had any effect. It helped! It was good to know I might at least have discovered the source of the pain. A couple hrs later I applied another round of ointment and took a couple Tylenol to supplement Dilaudid and was able to fall asleep. There does seem to be a neurological component because the leg seems uncomfortable under plush blanket I have been using. I’m thinking varicose veins may also be involved. I’m going to switch to a cotton quilt. Have dr appt today to discuss further but I think I’m on the way to some resolution. 🤞🏻

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@continentalred

Trouble sleeping post TKR is not unusual. I would get up and go on my stationary bike for 5 minutes or walk around. When lying in bed one doesn’t get the same blood flow as they do during movement. You can also try lying on your back, elevate your legs and do bicycle riding exercises.
Perhaps ask your doctor for a prescription for Lyrica. This helps with nerve pain but also helps with sleeping

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Thanks for those tips. I have wondered if the pain could have neurological component and I did do a little more walking last night before retiring and think that too might be good idea. I tried using Diclofenac 8% Ointment last night and it definitely helped. Will discuss Lyrica with dr today.

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@evon

Thanks for those tips. I have wondered if the pain could have neurological component and I did do a little more walking last night before retiring and think that too might be good idea. I tried using Diclofenac 8% Ointment last night and it definitely helped. Will discuss Lyrica with dr today.

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Nerve pain has been my biggest complaint. I am almost 5 months post op and the pain has settled down to itching and burning. Definitely worse during the night.
Surgeon said it was all part of nerve regrowth.
Occasionally I might take Lyrica now but in the beginning I don’t know what I would have done without it

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@continentalred

Nerve pain has been my biggest complaint. I am almost 5 months post op and the pain has settled down to itching and burning. Definitely worse during the night.
Surgeon said it was all part of nerve regrowth.
Occasionally I might take Lyrica now but in the beginning I don’t know what I would have done without it

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After rounds of hip replacement surgery, the final nerve regrowth took over a year...I learned after one of many ortho surgeries that once tissue is healed, nerve regrowth/regeneration can happen at a rate of 1-3 mm/day - that's really slow. And as the nerves mend, the sensations and location change constantly - it can be so frustrating!
Sue

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@evon

Two weeks since TKR. About a week ago started having nights with significant knee pain that radiates down shin, into ankle and sole of foot. Pretty much always starts at midnight and goes to around 5 am. Anyone else have similar experience?

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I had problems sleeping after my TKA. Ice helps and I had to start Gabapentin 300 mg at bedtime for neuropathy in my foot, which developed after the surgery. I also took Ambien which helped greatly. I am now 6 months post TKA and still taking Gabapentin. Good luck!

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@evon

Two weeks since TKR. About a week ago started having nights with significant knee pain that radiates down shin, into ankle and sole of foot. Pretty much always starts at midnight and goes to around 5 am. Anyone else have similar experience?

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i used ice machine I would be able to leave on overnight… I would put towel between the pad and my knee …. I also had tuff time sleeping after surgery…I used olly with melatonin it says you can take 2 but I only needed to take 1 was very helpful…..getting a good night sleep is so important to recovery….for your body and mind…. I included a pic of olly hope it helps

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@tka0722

I had problems sleeping after my TKA. Ice helps and I had to start Gabapentin 300 mg at bedtime for neuropathy in my foot, which developed after the surgery. I also took Ambien which helped greatly. I am now 6 months post TKA and still taking Gabapentin. Good luck!

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Thank u for the info. I find the sleep interruption hard because I had a very good sleep pattern. Hoping I’ll be able to get that back. It seems the diclofenac ointment is working relatively well so I’m going to stick w that & hope the problem will slowly resolve itself as the bruising subsides.

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@ezas123

i used ice machine I would be able to leave on overnight… I would put towel between the pad and my knee …. I also had tuff time sleeping after surgery…I used olly with melatonin it says you can take 2 but I only needed to take 1 was very helpful…..getting a good night sleep is so important to recovery….for your body and mind…. I included a pic of olly hope it helps

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I agree wholeheartedly re the healing effects of sleep. Thus far I’m not having a lot of difficulty getting to sleep but the interruption when the leg pain starts is frustrating. I seem to have gotten it down to about 1.5 hrs vs 5 hrs of sleeplessness due to leg pain. Hoping that will improve as I do the treatment & (hopefully) pain subsides as bruising heals. Thanks for the tip re Olly. Best wishes to u.

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@evon

Thank u for the info. I find the sleep interruption hard because I had a very good sleep pattern. Hoping I’ll be able to get that back. It seems the diclofenac ointment is working relatively well so I’m going to stick w that & hope the problem will slowly resolve itself as the bruising subsides.

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I have found diclofenac ointment as well as Ben Gay works well for me. I use it 3x a day on my knee and shin. I do take Gabapentin at bedtime (I did prior to surgery) and started back after my surgery. I briefly weaned off it due to taking pain meds (which I will never again that long).

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@evon

Thank you. You’re so right about the “assault on the body”. I’m already doing the other things and find Tylenol just doesn’t do anything for the pain. Even the Dilaudid didn’t touch it. However, last night I came to the realization that the pain comes from all the areas of my leg & foot that are all bruised and black & blue post surgery (hence the “assault on the body”). The pain is severe, much worse than the surgical pain. I decided to rub Diclofenac 8% Ointment that I had on hand into the area to c if that had any effect. It helped! It was good to know I might at least have discovered the source of the pain. A couple hrs later I applied another round of ointment and took a couple Tylenol to supplement Dilaudid and was able to fall asleep. There does seem to be a neurological component because the leg seems uncomfortable under plush blanket I have been using. I’m thinking varicose veins may also be involved. I’m going to switch to a cotton quilt. Have dr appt today to discuss further but I think I’m on the way to some resolution. 🤞🏻

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You are so right about the neurologist component
I am now 6 months post op and the pain from nerve regeneration has been the most difficult for me.
Much better now but don’t know what I would have done without a prescription for Lyrica which addresses nerve pain as hydromorphone did not give me any relief

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