Use of melatonin may yield longer sleep duration after THA
Key takeaways:
- Patients prescribed melatonin after total hip arthroplasty reported more hours slept postoperatively.
- Patients in the melatonin group also reported lower sleep disturbance scores.
SAN DIEGO — Results presented at American Academy of Orthopaedic Surgeons Annual Meeting showed patients undergoing total hip arthroplasty who were prescribed melatonin reported longer sleep duration in the immediate postoperative period.
“Melatonin may be of benefit in the first few weeks after surgery,” Joshua C. Rozell, MD, academic orthopedic surgeon at NYU Langone Health, told Healio. “The benefits probably wane after the first couple of days, and there was no difference in nighttime awakenings and sleep disturbance after the first couple of days, but it may be a nice adjunctive measure to offer patients if they are having sleep problems after hip or knee replacement.”
Rozell, Farouk J. Khury, MD, and colleagues randomly assigned 139 patients undergoing primary, elective THA between July 2021 and March 2024 to receive either 5 mg of melatonin or placebo for 14 days postoperatively.
In his presentation, Khury said patients reported nightly pain through VAS, number of hours slept and number of nighttime awakenings in a 14-day sleep diary starting on postoperative day 0. The number of hours slept were measured separately for postoperative days 1, 2 and 3, and the average was collected on postoperative days 4 to 6, 7 to 9 and 10 to 14, according to Khury. He added sleep disturbance was assessed with the Patient-Reported Outcome Measurement Information System (PROMIS)-Sleep Disturbance score both preoperatively and on postoperative day 14, while sleep quality was assessed with the Epworth Sleepiness Scale (ESS) on postoperative day 14.
“The primary outcomes included numbers of hours slept, numbers of nightly awakenings and the PROMIs-Sleep Disturbance score,” Khury, a clinical research fellow at NYU Langone Orthopedic Hospital, said during the presentation. “In terms of secondary outcomes, they included the nightly pain score and the ESS.”
Although patients in the melatonin group slept more hours at each time point, Khury said postoperative day 2 was the only time point with a statistically significant difference between the melatonin and placebo groups.
“We also measured the PROMIS-Sleep Disturbance score preoperatively and on postoperative day 14, and we measured the data between the two timepoints, which showed little change in Sleep Disturbance score from preoperative to postoperative time in the melatonin cohort,” Khury said. “The variation between the data were not statistically significant.”
However, according to Khury, there was a statistically significant difference in the PROMIS-Sleep Disturbance score at postoperative day 14, with patients in the melatonin group reporting lower Sleep Disturbance scores.
Rozell said more research is needed on the dosage frequency of melatonin, the type of medications patients are taking at night and if there are other adjunctive measures that can assist with sleep disturbance postoperatively.
“Setting patient expectations early on about having difficulties with sleep after surgery will be important in making sure patients have a good functional recovery,” Rozell told Healio.
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Khury FJ, et al. Paper 343. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.
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