Patient Expectations of Sexual Activity After Total Hip Arthroplasty: A Prospective Multicenter Cohort Study

This study aimed to evaluate patients' expectations of postoperative sexual activity (SA) after total hip arthroplasty.

A prospective multicenter cohort study of 1,271 patients managed with total hip arthroplasty was performed using patient-reported outcome measures of the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis Study (LOAS). Preoperative SA expectations and their fulfillment after 1 year were assessed with the Hospital for Special Surgery expectations survey. The Hip disability and Osteoarthritis Outcome Score (HOOS) was used to measure functional status, and the Short Form-12 Mental and Physical Component Summary scores (SF-12 MCS and SF-12 PCS) and EuroQol-5 Dimensions (EQ-5D) questionnaire were used to measure health status. Two subgroups were defined preoperatively: the SA-Expecting Group and the No-SA-Expecting Group. The postoperative outcomes with regard to SA (i.e., the difference between postoperative and preoperative SA scores) were classified as "unfulfilled" (score, ≤-1), "fulfilled" (score, 0), or "exceeded" (score, ≥1). Multivariate regression analyses were used, with t tests to compare means between groups.

In total, 952 (74.9%) patients returned both preoperative and postoperative HSS questionnaires. Preoperatively, 605 patients (63.6%) expected to have postoperative SA. At 1 year, 43.5% of participants reported that this expectation was unfulfilled. In the No-SA-Expecting Group, 18.2% (63 of 347) regained SA, predominantly men. Postoperative SA fulfillment was related to preoperative musculoskeletal (p = 0.001) and non-musculoskeletal comorbidities (p = 0.004) and the postoperative HOOS, SF-12 PCS, SF-12 MCS, EQ-5D, and EQ-5D visual analog scale (VAS) scores (p < 0.001). Postoperative HOOS-symptoms (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.02 to 1.06; p < 0.001), and HOOS-sport (OR, 1.01; 95% CI, 1.00 to 1.03; p = 0.032) were associated with postoperative SA fulfillment, as was older age (inversely; e.g., ≥76 years compared with ≤60 years: OR, 0.28; 95% CI, 0.13 to 0.62; p = 0.002). Correspondingly, for the No-SA-Expecting Group, higher age was also inversely associated with regaining postoperative SA (e.g., ≥76 years: OR, 0.07; 95% CI, 0.02 to 0.21; p < 0.001).

Of the patients who expected to be sexually active after surgery, 43.5% perceived this expectation to be unfulfilled; 24.3% were still sexually inactive despite most having expected a return to normal SA. Approximately one-fifth of patients who did not expect postoperative SA in fact regained SA. During preoperative consultations, surgeons should pay attention to expectation management surrounding SA.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.