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    What about Sex after Joint Replacement Surgery?

    First, a story:

    Years ago, during her orthopedic residency training in Minnesota, Dr. Lajam encountered a patient whom she remembers very well. He is a farmer in his seventies who has done heavy work his whole life. He has terrible arthritis in his hips. He can barely move them, walks with a severe limp and has pain all the time. X-rays of the hips show advanced arthritis.

    He had been coming to Mayo for years for his hip arthritis. His wife of more than 40 years would accompany him and would seldom speak. Each time, he was told he would benefit from a hip replacement and each time, he refused. He would just "live with the pain."

    This year, however, our friend the farmer has a change of heart. When hip replacement is mentioned, he and his wife eagerly ask for the first available surgery date.

    "Why, after all of these years with horrible pain and loss of motion in your hips, have you decided to have a hip replacement now?" asks Dr. Lajam. The farmer and his wife look at each other and smile. They clasp hands and a slight blush comes to the farmer's face. Then, his wife speaks.

    "Well, doctor... we've discovered Viagra®!"

    The moral of the story:

    With the availability of medication to enhance sexual function, older people are rediscovering their sexual relationships with their partners.

    However, many patients give up sexual activities because of pain and loss of motion in their joints. After joint replacement and a period of recovery, pain can be greatly decreased and motion can be greatly improved. In a recent study, 67% of total joint replacement patients noted improvement in their sexual relationships. 

    With knee replacement, most people can return to their former sexual activities and positions. With total hip replacement, the possibility of dislocation in the early stages of healing makes it wise to avoid certain positions during the first three months.  Most patients with hip replacement can eventually resume their normal sexual activities after the first few months.  While the direct anterior hip approach decreases the risk of early dislocation, the incision for this approach is at the front of the pelvis, which might make sexual activity uncomfortable until the wound is healed.

    When can I resume sexual activity?

    After the surgical wound heals and the tissues around the total joint form a new capsule around the joint, it is generally safe to engage in sexual activity. For most patients, this occurs at 4 to 6 weeks after surgery. Some patients can resume some positions earlier than this.  Ask Dr. Lajam about this at your 4-6 week postoperative visit.

    What positions are best for total hip replacement?

    There are "safer" positions to use for sexual activity. In general, the total hip patient ("THP") should follow the restrictions taught during physiotherapy. The physical therapist can assist in answering some questions that may arise.