Postoperative Recovery Beyond Pain: The Underrecognized Burden of Sleep and Appetite Impairments After Total Hip and Knee Arthroplasty

Background: Postoperative disturbances in sleep and appetite, though common after lower limb arthroplasty, are frequently overlooked despite their significant impact on recovery and quality of life.This study aimed to evaluate the temporal profile of these symptoms and their associations with pain and opioid use.Methods: A prospective observational study was conducted on 150 patients undergoing elective hip or knee arthroplasty at a tertiary care center in eastern India.Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and appetite was measured using the Simplified Nutritional Appetite Questionnaire (SNAQ) at four time points: preoperatively and at 1 week, 1 month, and 3 months postoperatively.Pain (Visual Analog Scale) and opioid intake were also evaluated.Subdomain analysis of PSQI was performed, and subgroup comparisons were made between THR and TKR groups.Results: Sleep and appetite declined markedly in the first postoperative week (PSQI: 4.21.8 to 9.12.5;SNAQ: 16.01.5 to 13.12.2;both p<0.001), followed by gradual recovery by 3 months.Sleep latency, sleep disturbances, and daytime dysfunction were the most affected subdomains.TKR patients exhibited more severe sleep disruption and higher opioid consumption compared to THR patients.Poor sleep and appetite were positively correlated with pain severity and opioid dosage (p<0.01).Conclusion: Sleep and appetite disturbances are multifactorial in the early postoperative period following arthroplasty.Their association with pain and opioid use underscores the need for early identification and comprehensive management.Multidisciplinary approaches incorporating analgesic optimization and nutritional counselling are recommended to enhance recovery and patient satisfaction.