In knee replacement surgery, also known as total knee arthroplasty, a surgeon will replace damaged cartilage and bone with an artificial implant.

The procedure can reduce pain and discomfort and improve your quality of life. Sometimes, however, it can have a negative impact on a person’s state of mind.

For 90 percent of people, knee replacement surgery improves their pain levels, mobility, and quality of life.

Like other major surgeries, however, it does carry certain risks.

After the procedure, some people experience changes to their state of mind, such as anxiety, depression, and insomnia.

Various factors could cause you to feel this way after surgery.

These can include:

  • decreased mobility for a while
  • an increased dependency on others
  • pain or discomfort
  • the side effects of medication
  • concerns about the recovery process

If you notice changes in your state of mind after knee replacement surgery, you aren’t alone.

If you experience significant effects that don’t go away within two weeks, speak to your doctor. They will be able to work with you to find a solution.

Insomnia is a sleep disorder that makes it difficult to go to sleep or to stay asleep.

Discomfort and pain may affect your sleep after a knee replacement. Over 50 percent of people who have had knee surgery wake up in the morning with pain, according to the American Association of Hip and Knee Surgeons (AAHKS).

Medication use and restricted leg movements during the night can also contribute to sleeping problems.

Sleep is important for both mental wellbeing and physical healing. If you have trouble with insomnia, it is a good idea to try to find a solution.

Tips for managing insomnia

There are various ways of relieving insomnia, including 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 you have trouble sleeping at night. Some causes are preventable, such as extreme pain or discomfort related to your surgery. Your doctor may be able to help you find a suitable solution.

Prescription medications for sleep, such as zolpidem (Ambien), are also available. However, doctors don’t usually prescribe them as a first-line treatment.

Get some tips on how to sleep better with knee pain.

You will be able to move around your home and walk short distances after knee replacement surgery, but your activity is often fairly limited.

You are also likely to:

  • experience pain for several more weeks
  • be more dependent on others as you recover
  • be unable to move as freely as you wish

Together, these factors can create feelings of sadness and hopelessness, which are associated with depression.

Depression causes persistent and intense feelings of sorrow that don’t seem to go away.

It may impact your:

  • mood
  • thinking and behavior
  • appetite
  • sleep
  • interest in doing daily tasks and activities you usually enjoy

Depression isn’t uncommon after knee replacement.

In one small study, around half of the people who underwent knee replacement surgery said they had feelings of depression before leaving the hospital. Females were more likely than men to report depression.

The symptoms seemed to be most pronounced about 3 days after the operation.

Post-operative depression often results in:

  • changes in appetite
  • reduced energy
  • feelings of sadness about your state of health

Tips for managing depression

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
  • 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.

Why does depression happen after surgery, and what can you do about it?

Does knee surgery reduce depression?

In another study, researchers looked at the symptoms of depression before and after knee replacement surgery in 133 people.

Around 23 percent said they had symptoms of depression before surgery, but 12 months later, this figure was down to about 12 percent.

Those who had symptoms of depression were less satisfied with their surgical outcomes than those who did not have depression. This was true whether the symptoms were present before or after surgery.

If you have symptoms of depression that last longer than 3 weeks after surgery, speak to your doctor. They can help you make a plan to manage the symptoms.

If you have thoughts of harming yourself or others at any time, call 911 immediately and seek emergency medical attention.

Anxiety involves feelings of worry, panic, and fear.

Knee replacement is a major procedure. Anxiety can happen because you fear that your pain may not go away or that your mobility may not improve. However, these feelings of anxiety shouldn’t overwhelm you.

A study that looked at anxiety levels in people before and after knee replacement found that around 20 percent of people experienced anxiety before surgery. A year after surgery, around 15 percent had symptoms of anxiety.

If you have anxiety, you may feel apprehensive about your recovery. It can cause you to feel fearful about continuing therapy or moving your leg.

Tips for reducing anxiety

If you experience anxiety after surgery, it can affect your progress toward recovery. However, you can work with your doctor to find a solution.

Relaxation techniques, such as listening to soft music and doing deep breathing exercises, can help ease anxiety.

Your doctor may also prescribe medications to help you cope with short-term feelings of anxiety.

Tell your doctor if you have had a diagnosis of insomnia, depression, or anxiety before knee replacement surgery. Also, share your feelings about the surgery beforehand.

Your doctor can talk you through them and create a recovery plan that takes these factors into account.

You may not expect to develop depression, insomnia, or anxiety after surgery.

If they happen, speak to your doctor and consider sharing your feelings with friends and loved ones, too.

Managing anxiety, insomnia, and depression may help you recover. Whatever you are feeling now, know that you can and will feel better with time.