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Sleeping After Knee Replacement – 3 Best Positions

by | Dec 16, 2020 | Total Knee Replacement

Getting great sleep after a knee replacement is always a challenge! 

The most common advice is to sleep flat on your back with your surgical knee straight and elevated above your heart.

To do this many surgeons will recommend propping a pillow under your heel or purchasing a straight wedge pillow to place under your leg. 

But what about those individuals who cannot sleep on their back? What should they do?

1. Sleeping on your back –

Why is sleeping on your back the most common recommendation?


🟢 Sleeping on your back allows you to position your surgical knee in full knee extension.

🟢 It also allows you to elevate the surgical leg above the level of your heart to reduce swelling.


🔴 The challenge with this position is many individuals who have undergone a total knee replacement also suffer low back pain associated with spinal stenosis and are unable to sleep in this position.

🔴 Neck pain is also a common complaint for individuals who aren’t used to sleeping in supine (flat on your back.)


If your knee range of motion is improving along expected guidelines and you are not experiencing significant swelling, consider sleeping in any position that is most comfortable for you.


2. Is it safe to sleep on my side after knee replacement?

Yes, side sleeping positions are safe and sometimes recommended after knee replacement surgery.

If your knee range of motion is within the expected normal degrees based on the time since surgery then you are encouraged to sleep in any position that provides you the best restorative sleep.

Side sleep with sleep apnea

Side sleep with sleep apnea

There are two side sleeping position.

Position 1: is with your surgical knee down on the mattress. In this position the bed will contour to your leg.

You may still try to keep the knee straight while sleeping on this side.

Position 2: is with your surgical knee on top. In this position you may choose to use pillows to support the surgical leg and keep your knee above the level of your hip.

This position is harder to keep the knee in a fully extended position but again if your knee range of motion is within normal limits your goal is to simply sleep well.

3. Is it safe to sleep on my stomach after knee replacement?


Yes, sleeping on your stomach, also known as prone, is both safe and an effective way to improve knee extension.



The only real difference between sleeping on your stomach versus sleeping on your back with your leg propped is the prone position will not reduce swelling.

If you have always slept on your stomach or partially turned toward your stomach you should be fine to return to that sleeping position.

Some patients are concerned about the incision. If you experience significant sensitivity over the incision there are strategies to reduce this sensitivity, but there should not be any danger in allowing the knee to rest incision down on the mattress.

Where do you put a pillow after knee surgery?



When sleeping in supine (on your back) you will place one to three pillows under your surgical leg while attempting to keep your knee straight.

In the video below you can see how I arrange pillows under the surgical leg to reduce swelling and position the knee comfortably.

You may also choose to use a wedge pillow if it is easier. You can find a great wedge pillow by clicking this link and seeing the selection on Amazon. 


YouTube Viewer Asked?




Too many pillows to wrestle with Tony. Why not go to the living room and sleep in the recliner? Why not recommend a good OTC sleeping pill?”

If your range of motion is progressing well and a recliner allows you to get a great night sleep then by all means please use it.

But if swelling or knee extension are causing frustrations during the day a bed may be a better option. 

What does the research say?

Click here to read the full study:

Patients often develop significant sleep disturbances immediately after surgery, especially major surgery. Polysomnographic manifestations usually include severe sleep deprivation, sleep fragmentation, and decrease or loss of SWS and REM sleep during the night after surgery [,,]. Patients may report decreased sleep time, increased numbers of arousals or awakening, lowered sleep quality, and frequent nightmares []. During the subsequent postoperative period, sleep structure gradually returns to normal with a REM rebound within 1 week [].”

About the Author -

Anthony Maritato, PT has been a licensed physical therapist since 2006. He specializes in post surgical care and rehabilitation of total knee replacement and rotator cuff repair surgery.

Mr. Maritato is also nationally recognized as a therapist educator teaching courses related to Medicare reimbursement, contracting, and documentation.

Total Therapy Solutions LLC is Tony's primary practice which he owns with his wife Kathy who is also a licensed physical therapist.

Anthony Tony Maritato, PT

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