Pregnancy & Sexual Activity after Total Hip Replacement

Sexual Activity after Total Hip Replacement

Sexual activity is one of the key components of quality of life. Hip pain, deformity and stiffness associated with Avascular necrosis, Rheumatoid arthritis, osteoarthritis or dysplasia has been recognized as a cause of sexual difficulty in patients. Still, patients usually dont feel free to initiate discussions of their sexual activity with their surgeons, even though they may want to. No wonder this topic hardly appears in any preoperative or postoperative consultations between patient and doctor.

After THR, dislocation of the prosthesis is a frequent cause of implant failure that occurs because of impingement, which can result from premature sexual activity or the use of sexual positions not recommended after the procedure.

Timing:

Its safe whenever he or she (patient) feels comfortable, this may take usually 4-6 weeks after hip replacement. As long as patients adhere to the standard precautions we tell them about hip replacements, it's safe.

Patients are advised to take a mild pain medication about 20- 30 minutes before sex, which can help prevent minor aches, and to avoid taking medication so strong that it masks warning pain.

Safe Positions:

Patients who have had THR must follow three rules to avoid hip dislocation:

• Avoid internal rotation of the affected leg
• Avoid flexing the hip more than 90 degrees
• Avoid crossing the legs and ankles.

Sexual positions that respect these rules are permissible, although most recommendations are based on expert opinion, not biomechanical research. They include the missionary position, suitable for both men and women who have had THR; Woman on top, man on the bottom with the top position safe for women and the bottom position safe for men.

Patient Information booklet of Overlake Hospital Medical Center, Washington, explains four positions: face to face, with the man supine and the woman seatedon top, a position safe for either partner with THR; Sitting in a chair with the woman on top, straddling the man, which is safe for whichever partner has had THR; Woman lying on the edge of the bed with her feet balanced on a stack of cushions while the man kneels between her legs; and the side lying position.

Recently, there was a first of its kind objective analysis of realistic motion data for several common sexual positions to objectively evaluate relative risk of impingement and joint instability during sexual intercourse. They summarized that, sexual positions for women require extreme hip movements (high flexion combined with abduction and mostly external rotation), whereas sexual positions for men require less mobility (but with pronounced external rotation). This study demonstrated that bony or prosthetic impingement associated with joint instability occurred during sexual activity after THA. Some sexual positions could be hence potentially at risk after THA, particularly for women. Based on the data they provided suggesttions / recommendations to be used by clinicians while advising patients regarding sexual positions that may be practiced after Total Hip Replacement . Please see the attached illustration showing positions of safety from man and woman.

Pregnancy after total Hip Replacement

Childbirth and Vaginal delivery is feasible and not affected by the presence of a Total Hip Replacement. Pregnancy-related complications were not increased as a result of hip replacement. Pregnancy after THA is not associated with decreased survival of the prosthesis. Pain in the hip is common during pregnancy in these patients. Patients with pain in the groin, which persists after delivery, should be followed closely.

These suggestions and conclusions are based on available scientific and online literature. Patients are advised to exercise all the necessary precautions and safety instructions after Total Hip Replacement surgery

References:

• Charbonnier C, Chague S, Ponzoni M, Bernardoni M, Hoffmeyer P, Christofilopoulos P. Sexual activity after total hip arthroplasty: a motion capture study. J Arthroplasty. 2014;29:640647.
• Lajam C. What about sex after joint replacement surgery? Dr. Claudette Lajam. http://orthochick.squarespace.com/sexafterjointreplacement/
• Sex positions after joint replacement. Overlake Hospital Medical Center. https://overlake.kramesonline.com/HealthSheets/3,S,40019
• R. J. Sierra, R. T. Trousdale, M. E. Cabanela, Pregnancy and childbirth after total hip arthroplasty. J Bone Joint Surg [Br] 2004;87-B:21-4.