After a hip replacement, most people sleep on their BACK for the first few weeks, legs slightly apart, with a pillow between the legs if your team gave you one.
Sleeping on your good side is usually fine once you’re comfortable, as long as you keep a firm pillow between your knees and ankles. Sleeping on the operated side usually waits until about six weeks, or until your surgeon clears it.
How strict you need to be depends on how your hip was done. Your surgeon’s instructions come first. If they differ from anything here, use theirs.
Why the approach matters
The approach is the route the surgeon took to reach the joint. It decides which movements put the new hip at risk of dislocating (popping out) while the tissues heal, and so which sleeping positions to avoid.
Hip precautions usually last about the first six weeks. The AAOS guide to total hip replacement notes that the precautions vary with the approach your surgeon used.
- Posterior approach (from the back): the risky movements are bending the hip past a right angle, crossing the operated leg over the middle of your body, and turning the knee and foot inward. In bed, that means a pillow between your legs and no letting the top leg drop across when you’re on your side
- Anterior approach (from the front): many surgeons give fewer or no formal precautions. Some still ask you to avoid pushing the leg far backward or turning it outward. Side-lying with a pillow is often allowed as soon as it’s comfortable
- Lateral approach (from the side): precautions vary from surgeon to surgeon. The side of the hip is often tender to lie on for longer
Not sure which one you had? Ask. It changes the rules. See anterior vs posterior hip replacement and hip replacement precautions.
The best positions
- On your back: the easiest position to keep safe. Legs a little apart, toes pointing to the ceiling, not rolled in. A pillow or wedge between your legs stops the operated leg drifting across in your sleep
- On your good side: put one or two firm pillows between your knees AND ankles, thick enough that the operated leg stays level with your hip. A pillow behind your back stops you rolling
- On your operated side: usually from around six weeks, once the wound has healed, the side of the hip isn’t tender and your surgeon agrees. Keep the pillow between your knees
- On your stomach: usually only after your precautions have been lifted. Roll onto it slowly, with a pillow between the legs, and don’t twist
The pillow between your knees isn’t there for comfort. It’s there so your leg can’t wander while you sleep.
Rolling over safely
- Pillow in first: put it between your knees before you start to roll, not after
- Roll like a log: shoulders, hips and knees turn together, so the hip doesn’t twist
- Bend the knees slightly, but keep the hip well below a right angle if you had a posterior approach
Getting in and out of bed
- Bed height: when you sit on the edge, your hips should be level with or slightly higher than your knees. A low bed forces the hip to bend too far. Raise it with firm risers or a thicker mattress topper
- Getting in: sit on the edge, scoot back, then swing both legs up together as you lie back. Don’t lift the operated leg across the good one
- Getting out: slide to the edge on your back, lower the legs down together and push up with your arms. Many teams teach you to get out on the side of your operated leg so it never crosses the middle. Some teach the opposite. Use the method your physio showed you
- Covers and slippers: use a long-handled reacher or ask for help rather than bending forward to grab them
- Night trips to the bathroom: walker beside the bed, a night light on the route, and sit for a moment before you stand
Making nights easier
- Time your pain relief as prescribed so it is working at bedtime, not after you wake in pain
- Ice for 15 to 20 minutes before bed can ease the ache, with a thin cloth between the ice and your skin
- Do your exercises earlier in the evening so the hip has time to settle. See exercises after hip replacement
- Keep naps short so you’re tired enough at night
- Sleeping tablets: don’t add anything on your own on top of your pain medication. Ask your doctor or pharmacist
When sleep gets better
- Weeks 0 to 2: the most broken nights. Lying mostly on your back is hard if you’re a lifelong side sleeper
- Weeks 2 to 6: pain settles and many people manage good-side sleeping with pillows
- Around 6 weeks: the usual point your surgeon reviews precautions and many people start lying on the operated side
- Months 2 to 3: most people sleep much better, and many sleep better than before surgery because the arthritis pain that used to wake them has gone
For the full timeline, see hip replacement recovery week by week.
Go to the emergency department if
- You feel or hear a clunk and then have sudden severe pain, can’t put weight on the leg, or the leg suddenly looks SHORTER or turned in or out. This can be a dislocation. Don’t try to put it back yourself
- You are suddenly short of breath or have chest pain
Call your surgeon today if
- You have pain, swelling or warmth in your calf, or new swelling in the leg. These can be signs of a blood clot. See blood clot after surgery
- You have a fever or feel unwell, or the wound is getting redder, more swollen or is leaking
- Night pain is getting WORSE instead of better
Mention it at your next review if
- The side of the hip is still too sore to lie on after about three months
- You still can’t sleep more than a couple of hours at a time
On your back or good side, pillow between your knees, and let your surgeon decide when the operated side is ready.