Natural history of sleep before and after total joint arthroplasty is poor and unimproved by melatonin: A randomized controlled study
In brief
Melatonin lengthens sleep after hip replacement but does not improve quality
In a randomized trial of 48 total hip and knee arthroplasty patients, peri-operative melatonin increased nightly sleep hours for hip patients but did not raise overall sleep quality scores, opioid use, or recovery measures. Knee patients showed no sleep benefit. The findings highlight persistent sleep disruption after joint surgery and limited impact of melatonin.
- Journal
- SICOT-J (Q1)
- Published
- 15 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Alex Lancaster, Brenna E Blackburn, Shanna Loughmiller, Michael J Archibeck, Jeremy M Gililland, Lucas A Anderson
- PMID
- 42735358
- DOI
- 10.1051/sicotj/2026029
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (top studies of the week, 1 November 2026): Randomized trial of melatonin after total hip/knee arthroplasty
Abstract
INTRODUCTION: Poor sleep has been shown to affect surgical recovery with negative impacts on function and pain. Osteoarthritis can negatively impact sleep, as can surgery, making arthroplasty patients especially at risk for these ill effects both before and after surgery. Our study goals were to monitor sleep recovery and determine if perioperative melatonin could improve sleep quality compared to a placebo. METHODS: From 2020 to 2023, a cohort of 48 primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients were randomized to melatonin (n = 23) or placebo (n = 25) for 7 weeks (1 week preoperatively, 6 weeks postoperatively). Patients were excluded if they already used sleep aids or had a sleep disorder. Sleep questionnaires collecting daily sleep and opioid data were electronically administered pre- and postoperatively up to 3 months. Generalized estimating equations were used to assess longitudinal sleep and opioid use. RESULTS: THA patients in the melatonin group had significantly more hours of sleep than the controls, with the numbers available for this study (p = 0.009). However, this did not translate to improved sleep scores overall. There were no significant differences between the melatonin and control groups in the TKA patients. Sleep quality scores significantly improved over time for both hip and knee patients (p = 0.03). For THA patients, sleep scores did not return to baseline until 3 months postoperatively, whereas scores for TKA patients had improved beyond baseline by 2 weeks postoperatively. CONCLUSION: Sleep disturbance is ubiquitous prior to surgery, and quality and quantity are negatively impacted after TJA surgery as well. TKA patients' sleep improved by 2 weeks, whereas THA patients did not improve till 3 months after surgery. The addition of perioperative melatonin led to more hours of sleep for THA patients but did not otherwise positively impact sleep quality, opioid use, or recovery in primary TJA patients.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.