Wake up and hear this…Rush researchers have dug into a common complaint when it comes to life after total joint arthroplasty (TJR)—sleep problems. Apparently, we don’t know too much about this issue.
Post-TJR Sleep Quality: What Is Being Done?
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Daniel D. Bohl, M.D. is with the Department of Orthopaedic Surgery at Rush University Medical Center in Chicago, and a co-author on the study. He and his colleagues recently presented their findings at the annual meeting of the American Academy of Orthopaedic Surgeons. Dr. Bohl commented to OTW, “Many patients have trouble sleeping after TKA and THA. We wanted to quantify the numbers and see what patients did to help themselves sleep. This was a prelude to a future prospective study to look at what can we do to prophylaxis against sleep issues.”
The authors wrote, “A total of 105 patients who underwent primary total hip (THA) or knee (TKA) arthroplasty prospectively completed questionnaires during the preoperative, early postoperative, and late postoperative periods. The survey regarded the Epworth Sleepiness Scale, current sleeping habits, and patient perspectives of sleep quality and duration. In the early postoperative period, patients reported significant increases in sleep disturbance as denoted by increased length of time to fall asleep and mean nightly awakenings compared to preoperative baseline. At late postoperative follow-up, patients’ sleep quality subsequently improved above the preoperative baseline. Approximately 40% of patients tried a new sleeping method postoperatively, the most common being new pillow placement. No significant differences in pre- or postoperative sleeping trends were noted between THA and TKA patients.”
“Our findings suggest transient sleep disturbance in the early postoperative period is common with subsequent improvement by 10-month follow-up after a primary TJA. Given the growing importance of patient satisfaction in health care systems, it is important for orthopaedic surgeons to manage patient expectations while working with them to optimize sleep quality after TJA. A multimodal approach with preoperative counseling, early postoperative sleep modifications and possibly pre-emptive use of medications may improve transient sleep disturbance in TJA patients.”
Asked what many orthopedic surgeons don’t understand about the quality of sleep after TJA, Dr. Bohl commented to OTW, “I don’t think they fully understand why this happens and then suddenly improves at six weeks. I am also not sure everyone is aware how many patients this affects and how debilitating it can be for them. Prophylactic regimens should be assessed to see if this is something we can improve upon for our patients.”
Commenting on the patients, Dr. Bohl said, “I guess the surprise is that more patients did not ask for a sleep aid during this time frame.”
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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