Preoperative Sleep Patterns and Their Impact on Outcomes in Total Hip and Knee Replacement: An Observational Study

Background Researching modifiable preoperative risk factors is essential for improving outcomes following total joint replacement (TJR). This study explores whether preoperative sleep performance influences pain and recovery in the early postoperative period. Methods This prospective observational study was conducted at an academic elective orthopedic hospital, recruiting patients undergoing total hip replacement (THR) and total knee replacement (TKR). Preoperative sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). Measured outcomes included pain, oral morphine use, day of crutch mobility, independent bed transfer, and hospital length of stay. Results No statistically significant associations were found between preoperative PSQI scores and primary outcomes, although sex differences existed in THR patients regarding early postoperative pain. The correlation between PSQI and hospital stay was weakly positive for THR (r = 0.223, p = 0.082) and negligible for TKR (r = 0.041, p = 0.807). PSQI showed no significant correlation with early mobility (THR: r = 0.111, p = 0.391; TKR: r = 0.115, p = 0.491) or postoperative morphine use (THR: r = 0.108, p = 0.403; TKR: r = 0.170, p = 0.309). Female THR patients had higher pain scores on days 0 and 1 and poorer PSQI scores. Conclusions Preoperative sleep hygiene was not associated with hospital stay, mobility, or pain in the immediate postoperative period after TJR. However, sleep may impact long-term recovery, highlighting the need for further research on modifiable preoperative factors and sex differences in post-TJR rehabilitation.