Sleeping after total hip replacement (weeks 1–6): positions, pillows, and what actually helps!
- Emma Glynn
- Oct 20
- 4 min read
Updated: Nov 3
General information only; not personal medical advice.
By Emma Glynn - The Hip & Knee Physio
After a total hip replacement, days get easier before nights do. Finding a position that doesn’t wake you or your partner is half the battle. This guide covers week-by-week positions, pillow setups, and when to get a review.
A quick word on “precautions”
Your surgeon may give you movement precautions (often based on approach and individual factors). Follow your surgeon’s specific advice first. This guide is general and focuses on comfort, control, and common-sense loading.
Weeks 1–2: calm and supported
Back-lying (most predictable early on):
Place a firm pillow under both knees to reduce pull on the hip.
A small pillow under the calf/ankle can help if the leg feels heavy.
Side-lying (usually on the non-operated side):
Thick pillow between knees and ankles so the top leg doesn’t roll forward.
If your pelvis tilts, add a small towel under your waist to keep you level.
What to avoid early: deep twisting to reach the nightstand; low, soft mattresses that sink you into awkward angles.
Sleep routine that helps: 10–15 minutes before bed - gentle ankle pumps, slow knee straightens, and 3–5 easy sit-to-stands. (If any of these bite, reduce range or skip for now.)
Weeks 3–4: add options, keep support
Many people can tolerate short spells on the operated side now, with a thick pillow stack between knees/ankles and a small towel under the waist for level pelvis.
Back-lying tweak: try a lighter knee pillow (or none) if the hip feels stiff; keep the between-knees pillow handy for any side-lying.
Waking at 2 a.m.? Do 10 ankle pumps, one gentle position change, and a slow nasal breath cycle (4–6 breaths). Avoid long, fidgety tossing.
Weeks 5–6: wean supports, don’t rush
Gradually reduce pillow height if comfort allows.
Side-lying stints can be longer provided the hip stays well-supported and symptoms settle by morning.
If you’re pain-free for several nights, try removing one pillow layer at a time.
Common problems & fixes
“I get a sharp catch when I roll.”
Slow down the roll; move the pelvis and shoulders together like a log.
Slide a pillow along with you so the leg is supported the whole time.
“Hip aches after 20–30 minutes.”
That’s a sign to change position or add a small support (waist towel, knee pillow).
Daytime load matters: long, fast walks early on can steal from your night. Trim and rebuild.
“I can’t get comfy on my side at all.”
Park side-lying for a week. Use back-lying with a wedge under knees and retry later.
“Heat or ice?”
Either is fine for comfort. 10 minutes, cloth barrier, skin-safe.
Do I need a special pillow or wedge?
You don’t need anything fancy, but consistency helps. Pick a firm pillow stack that keeps the knees the same heightand the pelvis level. A thin towel is the secret weapon under the waist for side-sleepers.
When to get a review sooner
Worsening night pain that doesn’t settle over several nights
Hot/red swelling, persistent fever, or wound concerns
New numbness or weakness, or a fall
Pain that spikes the day after adding a new position and doesn’t ease within 24–48 hours
What we do in a first post-op session
History & goals → check positions, bed height, and transfers → practical sleep setup matched to your op side and surgeon instructions → daytime load plan (walk dose, simple control work) so nights improve faster.
Ready for nights that don’t wreck your mornings?
👉 Take my Knee Quiz if you’re unsure whether your symptoms need attention.
FAQs
Can I lie on my operated side?
Often yes by weeks 3–4, with good pillow support. If it hurts, leave it for a week and retry.
Is a recliner better than bed?
It can be a short-term option if back-lying in bed is rough. Aim to transition back to bed once pain and transfers are easier.
Do I need a special abduction wedge?
Only if your team prescribed one. Most people manage well with firm pillows used consistently.
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