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Natural history of sleep before and after total joint arthroplasty is poor and unimproved by melatonin: A randomized
Alex Lancaster1, Brenna E Blackburn2, Shanna Loughmiller2
1Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA - Orthopedic Surgerym, St. Charles Health System, 1342 NE Medical Center Drive, Bend, OR 97701, USA.
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.
