Knee replacement surgery, also known as total knee arthroplasty, involves replacing damaged cartilage and diseased areas of bone with new metal and plastic implants. The procedure is designed to reduce pain and discomfort. It can also help improve quality of life when someone has disabling arthritis, or repair damage to the knee joint.

Knee replacement surgery can help you feel better, but like other major surgical procedures, it does carry certain risks. These include changes to your state of mind, such as increased anxiety, depression, and insomnia.

There are a number of factors that can cause a person to go through these emotions after surgery, including:

  • decreased mobility
  • increased dependency on others
  • pain or discomfort
  • side effects of medication

If you notice changes in your state of mind after knee replacement surgery, know that you aren’t alone. It’s important to notify your doctor if you experience significant effects that don’t go away within a few weeks.

Insomnia is a sleep disorder that makes it difficult to go to sleep or to stay asleep. Many people experience sleep disruptions after knee replacement surgery due to discomfort. In fact, more than 50 percent of people who undergo knee replacement wake up with pain after surgery.

Insomnia can be relieved with medical treatments and home remedies. With your doctor’s permission, you may be able to take over-the-counter sleep aids, such as melatonin or diphenhydramine (Benadryl).

Other steps you can take to get better sleep after surgery include:

  • avoiding stimulants before bedtime, such as caffeine, heavy meals, and nicotine
  • doing something relaxing before bed, such as reading, writing in a journal, or listening to soft music
  • creating an environment that promotes sleep by dimming the lights, turning off any electronics, and keeping the room dark

Talk to your doctor if preventable causes of insomnia are keeping you from sleeping at night. This could include extreme pain or discomfort related to your surgery. Prescription medications for sleep, such as zolpidem (Ambien), are also available. However, they aren’t usually used as a first-line treatment.

While you will be able to move around your home and walk short distances after knee replacement surgery, your activity is often fairly limited. You may also be more dependent on others for a short period of time as you recover. This can create feelings of sadness and hopelessness, which are associated with depression.

Depression is a disorder characterized by persistent and intense feelings of sorrow for an extended length of time. It may impact your mood and behavior as well as various physical functions, including appetite and sleep. The disorder may also cause you to lose interest in doing daily tasks and activities you usually enjoy.

Depression isn’t an uncommon occurrence after knee replacement. A 2009 study in the Journal of Evaluation in Clinical Practicefound that 28 out of 56 people undergoing knee replacement reported experiencing feelings of depression before leaving the hospital. Females were more likely than men to report depression. Additionally, people reported the greatest levels of depression about three days after their operation.

Post-operative depression often results in changes in appetite, reduced energy, and feelings of sadness about your state of health. Sharing your feelings with family and friends can help, as can taking care of yourself in the post-operative period. This includes taking the following steps:

  • taking prescribed medications regularly
  • getting plenty of rest
  • participating in physical therapy exercises to help you grow stronger and recover as expected
  • reaching out to a therapist or counselor if you need to talk to someone

Symptoms of depression tend to subside within one year after the surgery. A study published in Osteoarthritis and Cartilage examined depressive symptoms in 133 people who underwent knee replacement surgery. Of those, approximately 23 percent reported experiencing depressive symptoms before surgery. Twelve months later, the percentage of people reporting depressive symptoms was only about 12 percent. The study also found that people with depressive symptoms before and after surgery were less satisfied with their surgical outcomes.
Call your doctor if your depressive symptoms persist beyond three weeks after your surgery. Your doctor will likely refer you to a mental health professional for further evaluation. If you have thoughts of harming yourself or others at any time, call 911 immediately and seek emergency medical attention.

Anxiety is characterized by feelings of worry, panic, and fear that aren’t in line with a particular situation. While knee replacement is a major surgical procedure, feelings of anxiety shouldn’t overwhelm you after surgery. However, you may experience anxiety because you fear that your pain may not subside or worry that your mobility may not improve.

A study published in Osteoarthritis and Cartilage evaluated anxiety levels in people before and after knee replacement surgery. The study found that most people experience anxiety prior to the surgery. The incidences of anxiety decreased from about 20 percent to 15 percent post-surgery.

Anxiety can be concerning because it causes you to feel apprehensive toward your recovery. You may feel fearful to continue therapy or to move your leg due to anxiety. If this is the case, it’s important to contact your doctor. While these fears can happen, they shouldn’t keep you from achieving recovery.

Relaxation techniques, such as listening to soft music and doing deep breathing exercises, can ease any anxiety you may feel after knee replacement. Your doctor may also prescribe medications to help you cope with short-term feelings of anxiety.

Tell your doctor if you have been diagnosed with insomnia, depression, or anxiety prior to knee replacement surgery. You should also share any emotions you may be feeling related to the surgery beforehand. Since these conditions are common side effects after surgery, your doctor can talk you through them and create a recovery plan for you.

You may not expect to develop depression, insomnia, or anxiety after your surgery. Should this happen, it’s beneficial to talk to close friends and loved ones about your concerns and emotions. This can help you cope with your condition as you recover. Most importantly, don’t give up on your recovery. Know that you can and will feel better with time.