High Rates of Interest in Sex in Patients With Hip Arthritis

Being sexually active has been associated with a high quality of life. Unfortunately, the topic of sexual limitations in patients undergoing total hip arthroplasty (THA) has not been well studied.

(1) What proportion of patients experience sexual limitations because of hip arthritis before THA; (2) whether patient reports of sexual limitations would be associated with poorer results on general health and hip-specific instruments; and (3) whether patient reports of sexual limitations would be associated with poorer preoperative range of motion.

Between May 19, 2003, and August 17, 2009, 403 patients (423 hips) underwent primary THA; of those, 237 patients/hips (59% [237 of 403]) had addressed the new patient questionnaire within 1 year before surgery and had it available for review; and of those, 192 (48% [192 of 403]) had answered the question about sexual function on their questionnaire. This group included 159 patients who were sexually active (82% [159 of 192]). These patients were defined as our study cohort. Among them, 131 patients (82% [131 of 159]) reported some degree of sexual limitations and 28 patients (18% [28 of 159]) did not report limitations. Patient characteristics evaluated included baseline demographics, body mass index, American Society of Anesthesiologists, Charlson in addition to preoperative/postoperative pain intensity/frequency (visual analog scale, 0-10), SF-36, WOMAC, and baseline hip range of motion measures. Outcomes of interest were compared between both groups. Mean age was 65 years. Chi-square, t-tests, and multivariate analysis of variance were used. Alpha was set at 0.05.

Hip arthritis interfered with the sexual life of 82% (131 of 159) of sexually active patients, more so in women than men (96% [68 of 71], versus 72% [63 of 88]; odds ratio, 8.99; 95% confidence interval, 2.588-31.258; p = 0.001). Preoperatively, patients with sexual limitations had a mean pain intensity of 8 ± 1.84 points on the visual analog scale, whereas patients without limitations had 6 ± 1.99 points (p < 0.001). Differences were also found in WOMAC pain (11 ± 3.9 versus 8 ± 3.5; p = 0.004) and WOMAC stiffness (3.4 ± 2.3 versus 1.4 ± 1.7; p = 0.001). Baseline hip flexion (84° ± 22.4° versus 93° ± 16.5°, respectively; p = 0.04) and external rotation (23° ± 14.5° versus 30° ± 11.6°; p = 0.02) were also different.

Our data suggest that many patients getting a hip arthroplasty are sexually active but most patients who are sexually active have sexual limitations before surgery as a result of hip arthritis. Women are more affected than men. Patients with these limitations experience more pain and have less flexion and external rotation before surgery. Preoperatively, counseling on sexual activities should be routinely discussed with all patients undergoing THA.

Level III, prognostic study.