Sexual activity after total hip arthroplasty: a motion capture study

The Effects of Sexual Education on Sexual Function and Sexual Quality of Life of Women Who Underwent Total Hip Arthroplasty: A Randomized Controlled Trial

BACKGROUND

This study aimed to determine the effect of sexual education on sexual function and quality of activity after Total Hip Arthroplasty (THA).

METHOD

There were 31 patients who underwent THA who were randomly assigned to the education (n = 15) and the control (n = 16) groups in this randomized controlled trial. A sexual education session and an educational handout were provided to the study group after THA prior to discharge. Patients were evaluated four times throughout the study: preoperatively, at 1, 3, and 6 months after surgery. The data was collected by using the sociodemographic and medical data form, the Index of Female Sexual Function (IFSF), the Sexual Quality of Life Questionnaire-Female (SQoL-F) questionnaire, the Visual Analog Scale (VAS) of the Fear of Sexual Activity, and the VAS of Satisfaction with Sexual Activity scales.

RESULTS

The mean sexual activity satisfaction score of the education group was higher in the second (95% Cl [confidence interval] [0.67 to 3.08]) and third follow-up (95% Cl [0.19 to 3.03]) (P < 0.05). Over time, the mean satisfaction scores of both groups increased (P < 0.05). The mean VAS fear of sexual activity scores at the first (95% CIs [-2.81 to -0.48]), second (95% CI [-4.71 to -2.80]), and third (95% CI [-3.80 to -1.55]) follow-ups of the education group were significantly lower. Over time, the mean fear scores of both groups decreased (P < 0.05). The education group had higher mean SQoL-F scores at the first (95% CI [4.90 to 33.11], second (95% CI [7.62 to 34.31]), and third (95% CIs [5.23 to 35.79) follow-ups (P < 0.05). For mean SQoL-F score, the difference between groups (F = 6.64), the change over time in both groups (F = 29.16), and the change over time between groups (F = 13.74) were statistically significant (P < 0.05). For the mean IFSF score, it was found that the change over time was significantly different for both groups (F = 69.64, P < 0.05).

CONCLUSION

Sexual education after THA may improve satisfaction with sexual activity and quality of life.

Effect of Stem Design and Positioning on the Leg Axis after Total Hip Arthroplasty: A Secondary Analysis

Background/Objectives: Various parameters, like femoral offset and leg length, are associated with good patient outcomes after total hip arthroplasty. In this prospective study, the effects of stem design, its placement in the proximal femur and the resulting femoral offset on the total leg axis were investigated. Methods: The 27 patients included in this study received biplanar radiography (EOS®, EOS Imaging) with 3D reconstruction using sterEOS® both preoperatively and postoperatively. For all leg alignment parameters obtained from the 3D reconstruction and from measurements using mediCAD, the deltas between the postoperative and preoperative values were determined. Patients were divided into those who received a short-stem prosthesis and those who received a straight-stem prosthesis. Results: The change in femoral offset with the implantation of a short-stem prosthesis was significantly greater than that with the implantation of a straight-stem prosthesis (11.4 ± 5.9 vs. 4.6 ± 7.4 mm, p = 0.014). Compared with the straight-stem implantation, short-stem implantation caused a significantly greater increase in the varus orientation of the leg (-1.4 ± 0.9 vs. -0.4 ± 1.4°, p = 0.048). There was no significant difference in the positioning of the short-stem prosthesis compared to the straight-stem prosthesis in the proximal femur (3.6 ± 3.1 vs. 2.6 ± 1.9°, p = 0.317). Conclusions: These findings substantiate the impact of prosthesis design on offset and leg alignment. The implantation of short-stems is more variable and requires precise planning. Intraoperative non-physiological offset changes and varus deviation of the leg axis should be avoided. Trial registration: This study was retrospectively registered with the German Clinical Trials Register (DRKS) under the number DRKS00015053 on the 1 August 2018.

Sexual activity at 1 year after total hip arthroplasty in Indian patients

PURPOSE

This study aimed to report changes in sexual activity and related difficulties and concerns among Indian patients at the end of 1-year after primary total hip arthroplasty (THA).

MATERIALS AND METHODS

A detailed questionnaire related to sexual difficulty, frequency, position, satisfaction, stress, and concerns pre- and postoperatively was administered through an in-person interview at 1-year post-THA.

RESULTS

Preoperatively, 77% of patients reported difficulties in sexual activities, which reduced significantly (p < 0.0001) to 30% at the end of 1-year post-operatively. A majority of patients reported no change in the frequency (56.5%) or satisfaction with their sexual activity (54%), and moderate to severe stress (53%) related to sexual activity at 1 year postoperatively. A significantly higher percentage (p = 0.01) of female patients (63%) reported changing their coital position postoperatively due to difficulty in leg positioning when compared to male patients (37.5%). Most patients (69%) were not able to procure information on sexual activity after THA surgery. and only 17.5% of patients discussed the topic with their surgeon.

CONCLUSION

Although THA significantly reduced difficulty in sexual activity, most patients reported no change in the frequency of sexual activity or sexual satisfaction, had moderate to severe stress regarding sex, and were primarily concerned about safety of coital position and fear of dislocation at the end of 1-year postoperatively. Pre- and postoperative counselling by their surgeons will provide the patient with relevant information and help reduce anxiety and stress, improve satisfaction, and enhance the overall sexual health of the patient undergoing primary THA.

Safe Sex After Total Hip Arthroplasty: Using Computed Tomography-Based Robotics to Evaluate "At-Risk" Sexual Positions

BACKGROUND

Total hip arthroplasty (THA) can improve sexual satisfaction, but fear of dislocation can lead to sexual difficulties following this procedure. Previous kinematic research identified 4 sexual positions in women and 2 in men that were considered at risk for impingement. This study aimed to validate these findings using current robotic THA simulations.

METHODS

The 3-dimensional renderings from 12 patients who received computed tomography (CT)-based robotic THA were used to assess for prosthetic and/or bony impingement among 12 popular sexual positions. There were 9 cup orientations tested for each position (a combination of anteversion [0 °, 15 °, and 30 °] and inclination [40 °, 45 °, and 60 °]). The at-risk positions were tested again using the unique hip positions and cup orientations where previous geometric modeling data found impingement to occur.

RESULTS

Using mean hip positions, impingement occurred in at least 1 patient in 1 of the 12 positions for women (position 5) and 5 of the 12 positions for men (positions 1, 5, 8, 10, and 11). Among the at-risk positions, impingement occurred in none of the 2 at-risk women positions (0 of 17 cup orientations) and in both at-risk men positions (9 of 9 cup orientations for position 8 and 1 of 1 for position 11).

CONCLUSION

Recreating popular and at-risk sexual positions following THA with a CT-based robotics system yielded results that were inconsistent with previous geometric modeling data. Resolving these discrepancies is crucial for surgeons to provide accurate postoperative patient education. The CT-based robotic systems may provide necessary input to feasibly individualize such recommendations, but current limitations in CT-based robotics require continued attention and innovation.

Sexual Disability in Low Back Pain: Diagnostic and Therapeutic Framework for Physical Therapists

BACKGROUND

The literature shows a relationship between sexual activity and low back pain (LBP). The aim of this work is to provide a theoretical framework and practical proposal for the management of sexual disability in individuals with LBP.

METHODS

Based on a literature review, a team of specialized physical therapists developed a pattern for the management of LBP-related sexual disability.

RESULTS

A patient reporting LBP-related sexual disability may be included in one of four clinical decision-making pathways corresponding to one of the following: #1 standard physical therapy (PT); #2 psychologically informed physical therapy (PIPT); #3 PIPT with referral; or #4 immediate referral. Standard PT concerns the management of LBP-related sexual disability in the absence of psychosocial or pathological issues. It includes strategies for pain modulation, stiffness management, motor control, stabilization, functional training, pacing activities comprising education, and stay-active advice. PIPT refers to patients with yellow flags or concerns about their relationship with partners; this treatment is oriented towards a specific psychological approach. "PIPT with referral" and "Immediate referral" pathways concern patients needing to be referred to specialists in other fields due to relationship problems or conditions requiring medical management or pelvic floor or sexual rehabilitation.

CONCLUSIONS

The proposed framework can help clinicians properly manage patients with LBP-related sexual disability.

Personalized 3D printed scaffolds: The ethical aspects

Personalized 3D printed scaffolds are a new generation of implants for tissue engineering and regenerative medicine purposes. Scaffolds support cell growth, providing an artificial extracellular matrix for tissue repair and regeneration and can biodegrade once cells have assumed their physiological and structural roles. The ethical challenges and opportunities of these implants should be mapped in parallel with the life cycle of the scaffold to assist their development and implementation in a responsible, safe, and ethically sound manner. This article provides an overview of these relevant ethical aspects. We identified nine themes which were linked to three stages of the life cycle of the scaffold: the development process, clinical testing, and the implementation process. The described ethical issues are related to good research and clinical practices, such as privacy issues concerning digitalization, first-in-human trials, responsibility and commercialization. At the same time, this article also creates awareness for underexplored ethical issues, such as irreversibility, embodiment and the ontological status of these scaffolds. Moreover, it exemplifies how to include gender in the ethical assessment of new technologies. These issues are important for responsible development and implementation of personalized 3D printed scaffolds and in need of more attention within the additive manufacturing and tissue engineering field. Moreover, the insights of this review reveal unresolved qualitative empirical and normative questions that could further deepen the understanding and co-creation of the ethical implications of this new generation of implants.

Sexual activity satisfaction in symptomatic hip osteoarthritis patients: A cross-sectional, national web-based study

AIM

Despite high-interest rates in sex in people with hip osteoarthritis (OA), clinicians tend not to address sexual issues, especially in older adults. The objective of this study is to evaluate sexual activity and factors associated with sexual activity satisfaction in people with symptomatic hip OA.

METHODS

A cross-sectional study was conducted among 252 participants with symptomatic hip OA in Australia. Quality of sex life was assessed using the online composite of sexual activities and positions questionnaires. A Poisson model with robust variance was used to calculate the prevalence ratio (PR). Factors that showed a univariate association with sexual satisfaction were then included in a multivariable model. PR with corresponding 95% confidence intervals (CI) are reported.

RESULTS

Among the 282 participants registered on the study website, 252 met the inclusion criteria, and 60.3% (152/252) completed the sexual activity questionnaires. Hip OA interfered with sexual activity in 70.0% of the participants. High confidence in completing sexual activity (PR: 0.53, 95% CI: 0.36 to 0.77) was associated with an increased prevalence ratio of sexual satisfaction. High anxiety, depression or stress during sexual activity (PR: 1.33, 95% CI: 1.10 to 1.60) was associated with an increased prevalence ratio of sexual dissatisfaction after adjusting for hip pain level and perceived partner's orgasm.

CONCLUSION

Although a large proportion of people with hip OA remain sexually active, a substantial proportion of persons are dissatisfied with their sexual activity. Hip OA interfered with sexual activity in most participants. Psychological factors were found to be associated with sexual activity satisfaction.

Sexual activity after short-stem total hip arthroplasty. Does stem size matter?

BACKGROUND

Sexual activity is an important component of quality of life. To date, no studies have examined the impact of stem design on return to sexual activity (RTS) and quality of sex life after total hip arthroplasty (THA).

METHODS

A questionnaire was designed to assess preoperative and postoperative sexual habits, joint awareness and physical activity in working-age patients undergoing short-stem (n = 176) or straight-stem (n = 97) THA.

RESULTS

No differences were noted in time until RTS based on the stem design (short stems vs. straight stems; 6 [IQR: 4-10] vs. 6 [4-10] weeks; p = 0.996). Multivariate analysis revealed that higher patient BMI (p = 0.04), female gender (p < 0.001) and lower FJS-12 (p = 0.006) were significantly associated with delayed RTS. Improved hip mobility and reduced pain mainly contribute to improved quality of sexual activity postoperatively.

CONCLUSION

This study, hence, indicates that stem design has no impact on time until resumption of sexual activity in patients < 65 years. Female obese individuals who are aware of their artificial joint in daily life are at increased risk of delayed RTS after surgery.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Sex and Gender-Related Differences in the Outcome of Total Hip Arthroplasty: A Current Concepts Review

Background and Objectives: Sex and gender-related differences may influence the outcome of patients undergoing total hip arthroplasty (THA). The present paper aims to depict the importance of sex and gender-related issues in the perioperative management of patients undergoing THA to improve clinical outcomes and prevent postoperative complications. Materials and Methods: From January 2002 to August 2022, OVID-MEDLINE, EMBASE, SCOPU S, Web of Science, Google Scholar, and PubMed were searched to identify relevant studies for further analysis. The search strategy included the following terms: (("gender-related differences" [MeSH Terms] OR "sex-related differences" [All Fields]) OR ("gender indicators" [MeSH Terms] OR "sex" [All Fields])) AND ("total hip arthroplasty" [MeSH Terms] OR (total hip replacement [All Fields])). Results: Twenty-eight papers were included in this current concepts review. Sex and gender-related differences were analyzed with regard to the following points: (1) surgical approach, robotic surgery, scar cosmesis, and implant choice; (2) postoperative clinical outcome and complications; (3) sexual activity after THA; and (4) psychological status and daily functional requirements. The data analysis showed that female patients need more specific attention in the preoperative, intraoperative, and postoperative phases to improve clinical and functional outcomes, reduce complications risk, and manage patient satisfaction. Conclusions: THA outcomes may be influenced by sex and gender-related factors which should be carefully assessed and addressed in patients undergoing surgery to improve the postoperative outcomes of patients' satisfaction and reduce postoperative complications that can differ between the two sexes.

Length doesn't play a role - Sexual activity in men after short stem Total hip Arthroplasty

BACKGROUND

Chronic hip pain due to osteoarthritis or hip dysplasia has been shown to negatively affect many daily life aspects. One aspect, however, which persists underestimated is sexual health. The number of total hip arthroplasties (THA) are increasing, especially in young patients who have high functional expectations, not only to pain relief, but to an increase in hip mobility and quality of life as well as sexual activity.

AIM

(1) to report the demographic factors, (2) the sexual activity before and after THA, as well as the concerns related to sexual activity after THA and (3) the patient-reported outcome measurements (PROMs) in sexually active male patients.

METHODS

We evaluated the results of patients between 18 and 65 years of age following primary cementless short femoral stem THA using a direct anterior approach (DAA) at a midterm follow-up of 4 years. A web-based questionnaire (via SurveyMonkey) was chosen to assess frequency, positions, complaints, fears, dealing with the questions and PROMs. Our patients sexual activity was via The Sexual Health Inventory for Men (SHIM) validated.

RESULTS

Patients resumed their sexual activities after 6 weeks. The two main causes of difficulty in sexual activity before surgery were pain and limitation of the range of motion of the hip joint. Patients experienced less pain and an improvement in hip range of motion after THA. 89% of patients expressed a desire for more detailed and specific information on the subject. The patients foremost concern about muscle weakness, surgical scar or fear of dislocation. After 4 years follow-up our patients presented a significant improvement of the modified Harris Hip Score (mHHS) from 34.1 preoperative to 92.6 after THA.

CONCLUSION

THA improves the quality in sexual life, in relation to less pain and improvement in the range of motion, but not in the frequency of sexual activity. Men's sexual positions required less mobility and could therefore be considered safer.

What Are the Physical Demands of Sexual Intercourse? A Systematic Review of the Literature

The aim of this study was to systematically review the literature investigating the physical demands of sexual intercourse and to synthesize the evidence related to this research topic. Original studies published on PubMed, Scopus, and Web of Science up until April 2020 were examined. The Effective Public Health Practice Project scale was used to assess the methodological quality of each study. Eighteen studies analyzed physical demands during sexual intercourse through the physiological demands (n = 14) and kinematics (n = 4) of sexual intercourse. Sexual intercourse can elicit an energy expenditure of ~ 100 kcal (or ~ 6 metabolic equivalent units, METs) during the activity, mean heart rates between ~ 90 and ~ 130 beats per minute (bpm), and peak heart rates up to ~ 170 bpm. However, these physical demands may vary depending on health status, intercourse position, activity duration, intercourse phase, and sex differences. The movement pattern was cyclic in all positions and the greatest demands in lumbar spine flexion were found in the missionary positions for women. Missionary and side-lying positions elicited the greatest lumbar flexion movement in men. Regarding the movement of the hip joint during sexual intercourse, flexion, abduction, and external rotation mainly characterized the woman's movement while external rotation did so in the man. In conclusion, sexual intercourse may elicit moderate intensity physical demands, but these demands vary depending on contextual variables. In addition, not only studies combining physiological and kinematic analyses are necessary but also more high-quality studies need to be published in order to have a better understanding of the physical demands of sexual intercourse.

Evaluation of sexual quality of life after bilateral total hip arthroplasty surgery

BACKGROUND

Patients experience limitation of hip joint movement due to coxarthrosis, such limitation may affect the quality of sexual activity in patients. We aimed at investigating the postoperative quality of sexual life and evaluating the clinical satisfaction of patients who underwent bilateral total hip arthroplasty.

HYPOTHESIS

Postoperative sexual life quality improvement in patients undergoing bilateral total hip arthroplasty increases clinical satisfaction.

METHODS

The study included patients who underwent staged bilateral total hip arthroplasty surgery between June 2016 and January 2019. Each patient was evaluated using the sexual quality of life-female (SQOL-F) or Sexual quality of life-male (SQOL-M) questionnaire containing similar questions for both genders regarding sexual satisfaction.

RESULTS

Among all the individuals, 32 were sexually active (13 females, 19 males), and seven were not sexually active (6 females, 1 male) before the surgery. Among the 29 individuals (18 females, 11 males) who thought that their sexual life was negatively affected even before the surgery, 10 (1 female, 9 males) were found not to be negatively affected. Moreover, the sexual life of 18 females was negatively affected 27.93±14.5 months (range, 12-43) before hip arthroplasty and 11 males was negatively affected 19.5±11.0 months (range, 8-31) before the surgery as well. Twenty (10 females, 10 males) individuals stated an improvement in their sexual life, 13 (6 females, 7 males) individuals stated no change. Unfortunately, 6 (3 females, 3 males) individuals stated a degradation of their sexual activity after hip arthroplasty. Patients gained more than 60 degrees of hip range of motion and experienced significant reduction in pain after hip joint movements after surgery.

DISCUSSIONS

In our study, we evaluated sexual limitations before and after total hip arthroplasty surgery and postoperative sexual quality of life. Due to the increased range of motion of patients after surgery, the proportion of sexually active individuals increased and the sexual quality of life reached a satisfactory level.

LEVEL OF EVIDENCE

III; retrospective cohort study.

Sexual activity resumption after total hip arthroplasty: A satisfaction survey in 101 patients

BACKGROUND

We are not aware of studies conducted in France to assess information provided by surgeons about the impact of total hip arthroplasty (THA) on sexual activity or sexual activity resumption after THA. The objectives of this study in a cohort of patients seen after THA were to evaluate: (1) the time to sexual activity resumption, (2) whether sexual activity resumption was discussed with the surgeon and whether the patients wanted information on this point, and (3) the modalities and experience of sexual activity resumption according to demographic features.

HYPOTHESIS

Age and sex influence the timing and modalities of sexual activity resumption after THA.

METHODS

We conducted a single-centre prospective cohort study in consecutive patients who received follow-up for 6months after THA. Each patient completed an anonymised questionnaire on preoperative sexual activity, modalities of postoperative sexual activity resumption, information delivered by the surgeon, and expectations regarding the delivered information. The patients also specified their age and sex on the questionnaire.

RESULTS

Of 101 included patients, 49 were still sexually active before surgery. Of these 49 patients, 35 (71.4%) reported no difference in the frequency of sexual activity before and after THA. Only 4 (8.2%) patients did not resume sexual activity during follow-up. Older age was associated with a lower demand for information [odds ratio, 0.95; 95% confidence interval: 0.91-0.99 (p=0.01)]. Compared to the females, the males more often recovered similar sexual activity to that before surgery regarding frequency [18/20 vs. 17/29 (p=0.02)] and quality of sexual positions [15/20 vs. 9/29 (p=0.003)]. Males resumed sexual activity on average during the first 3weeks [10/20 (p=0.02)], compared to after 6weeks for most females [13/29 (p=0.03)]. Age was not associated with the time to sexual activity resumption [ρ=0.0868; 95% confidence interval: -0.205 to 0.365 (p=0.56)].

DISCUSSION

Among patients who were sexually active before surgery, 71.4% reported having resumed the same frequency of sexual activity 6months after surgery. The main difficulty in both males and females was fear of prosthetic hip dislocation, which was related in part to insufficient preoperative information. Males resumed sexual activity earlier than did females. In patients who were sexually active before surgery, age was not associated with the resumption of sexual activity after surgery.

LEVEL OF EVIDENCE

IV, prospective study with no control group.

Improved Sexual Function After Total Hip and Knee Arthroplasty for Osteoarthritis

Osteoarthritis of the hip and knee is known to affect sexual activity. For patients with osteoarthritis, pain during sexual activity can lead to decreased quality of life and other associated health issues. The authors designed a prospective study to evaluate the effect of total hip arthroplasty and total knee arthroplasty on the psychosocial and physical aspects of sexuality pre- and postoperatively. Between April 2009 and December 2011, patients received questionnaires in the mail preoperatively. They were asked to return the preoperative questionnaire before surgery and the postoperative questionnaire 6 months after surgery. Data were analyzed to evaluate the psychosocial and physical aspects of sexuality and participants' subjective assessment of their appearance. Preoperatively, 91% and 67% of patients reported psychosocial and physical issues, respectively. After the arthroplasty procedure, 84% (P<.001) and 47% (P<.001) of patients reported improvement psychosocially and physically, respectively. Of the patients, 16% reported that arthroplasty adversely affected sexual function, with their predominant fear being joint damage (63%). A greater number of women and patients undergoing hip procedures reported improvement in sexual activity after surgery compared with men (P=.02) and patients undergoing knee procedures (P=.002). Both hip and knee osteoarthritis and arthroplasty had a significant effect on overall sexual function-psychosocially, physically, and in terms of patients' assessment of their external appearance-with higher rates of improvement seen after hip arthroplasty. Because of the effect of osteoarthritis and arthroplasty on sexual function, this topic should be addressed both pre- and postoperatively. [Orthopedics. 2021;44(2):111-116.].

The impact of total hip arthroplasty on sexual satisfaction in female patients: a prospective before-and-after cohort study

PURPOSE

Despite the high rate of sexual limitation in female patients with hip osteoarthritis, evidence reporting sexual satisfaction after hip arthroplasty in women is limited. This study aimed to assess the impact of surgery on sexual satisfaction in women who undergo elective total hip arthroplasty (THA). As a secondary objective, we measured the effect of THA on different factors that could be related to sexual limitation and satisfaction.

METHODS

We designed a prospective before-and-after cohort study in which all consecutive women undergoing THA were screened for inclusion. Patients answered a ten question specifically designed questionnaire before and after surgery. An independent analysis was performed for each question through a McNemar-Bowker test for paired proportions.

RESULTS

Fifty-six patients completed the protocol and were available for analysis at the end of the study. Sexual satisfaction increased from 29% before surgery to 93% after the procedure (p < 0.001). All questions related to physical limitations demonstrated significant improvement after surgery. In addition, psychological aspects of limitation including fear of pain and injury, or perception of attractiveness, showed significant recovery as well.

CONCLUSION

There is a high rate of patients reporting limitations and disabilities during sexual activities among women with osteoarthritis. THA represents a positive impact on sexual functioning both in its physical and psychological aspects, thus increasing satisfaction rates in female patients. Surgeons should include these elements in the conversation with patients before and after surgery.

Evidence based rehabilitation after hip arthroplasty

BACKGROUND

Hip arthroplasty is considered the treatment of choice to improve the quality of life of patients affected by degenerative arthritis. The post-op rehabilitation regimen, however, is still a matter of debate. The goal of this study was to perform a systematic review of the available best evidence to provide recommendations for rehabilitation after hip arthroplasty.

MATERIALS AND METHODS

Biomedical databases were accessed to identify guidelines, systematic reviews and randomised controlled trials addressing rehabilitation after hip arthroplasty published between 2004 and 2019. Studies were selected and extracted by two independent evaluators with standardised tools.

RESULTS

1 guideline, 8 systematic reviews and 5 randomised controlled trials were included. All included papers were organised according the available evidence of clinical course chronology both in pre- and post-operation rehabilitation up to 6 weeks and thereafter. Although the value of a rehabilitation program after hip arthroplasty is universally recognised, the exact timing and number of sessions is still unknown. A solid literature review allows us to partially answer to this question.

CONCLUSIONS

Evidence-based rehabilitation recommendations are proposed according to literature research findings. Clinical practice is still somewhat dependent on dogma and traditions, highlighting the need for additional high-quality clinical studies to address areas of uncertainty.

Discussing sexual activities after total hip arthroplasty

BACKGROUND

Hip pathology can affect functions including sexual activity. Sex after hip replacement (SAHR) is an important subject for patients but rarely discussed. A conversation prior to surgery can be difficult to initiate, and appropriate advice is then not given. This study has set out to find how physicians approach the subject, and how patients would the like the subject to be addressed. Thus, device a process that ensures appropriate discussions take place prior to Total Hip Replacement (THR) in all patients.

METHODS

Questionnaires were given to clinicians and patients. The clinicians' questionnaire asked how they dealt with the issue of SAHR. All patients below the age of 80 were asked how the issue was addressed, and how this could be improved. The aim of this study was twofold. Firstly, to address how SAHR should be approached, both by reviewing the clinicians present views and asking the patients their expectations. Secondly, to develop a process that will ensure patients' concerns are appropriately and consistently addressed prior to total hip replacement (THR).

RESULTS

All 17 clinicians responded. None used any printed information to give to patients dealing with SAHR nor did they routinely discuss it with patients. 244/340 patients responded. Over 90% of patients wanted the surgeon to discuss sex after THR with them, and would be happy to be asked directly about the subject.

CONCLUSION

Clinicians do not routinely raise the subject of SAHR with patients, who often wanted to know, but rarely asked. There is unease around the subject, and therefore there is a need to establish a process that ensures this discussion takes place prior to THR.

Postoperative Sexual Activity Recommendations: Survey of Neurosurgeons/Spine Surgeons

OBJECTIVE

The impact of various types of spinal surgeries on sexual health and postoperative sexual activity is a common question among both patients and health care professionals. Unfortunately, there is no clear answer to this question in the scientific literature. Our goal was to survey the current practices and recommendations of neurosurgeons to see if there was a clinical consensus.

METHODS

Participants in the survey included 50 spine surgeons: 47 males and 3 females. The average age of the participants was 45.7 years old, and the number of years of practice after residency was on average 11.7 years. Additional survey questions included the number of weeks recommended for patients to abstain before returning to sexual activity after specified small, medium, and large spinal surgeries.

RESULTS

We found that there were no statically significant correlations between the participants' ages or years post residency and the time response for postoperative return to sexual activity. Some answers were significantly different among the participants. The results also showed a trend for spine surgeons to recommend longer intervals for return to sexual activities after more involved surgical procedures.

CONCLUSIONS

The survey results and comments demonstrate the complete lack of physician consensus regarding recommendations for postoperative return to sexual activity and the need for further study.

Validity and Reliability of a New Inertial Device for Monitoring Range of Motion at the Pelvis during Sexual Intercourse

To understand the physical demands of sexual intercourse, it is necessary to monitor the kinematic parameters of this activity using relatively non-invasive technology. The aims of this study are to analyze the validity and reliability of an inertial device for monitoring the range of motion at the pelvis during simulated intercourse and compare the range of motion (ROM). Twenty-six adults were monitored during intercourse using an inertial device (WIMU) and a motion capture system (gold standard) in a test that consisted of 4 sets of 20 simulated in-out cycles (IOC) in missionary and cowgirl positions. Men and women were tested separately in a laboratory setting for simulated intercourse aims. There were no differences between the WIMU and the gold standard system at fast pace (p > 0.05), whereas there were differences at slow pace (~2.04°; p ≤ 0.05; d = 0.17). Intraclass correlation coefficients (ICCs) for the relationship between systems was very close to 1 at both paces (slow: 0.981; fast: 0.998). The test-retest reliability analysis did not show any difference between sets of measurements. In conclusion, WIMU could be considered as a valid and reliable device for IOC range of motion monitoring during sexual intercourse in missionary and cowgirl positions.

Gender-Specific Sexual Activity After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Position Matters

BACKGROUND

There is limited evidence on the safety of return to sexual activity after hip arthroscopy.

AIM

To determine the positional safety of sexual activity after hip arthroscopy relative to hip instability and/or impingement risk.

STUDY DESIGN

This study is an observational study.

METHODS

12 common sexual positions were identified based on previous research. Gender-specific hip motion was then assessed for the possibility of postarthroscopic hip instability (due to disruption of iliofemoral ligament [interportal capsulotomy] repair) and/or impingement (labral or capsular compressive stress with disrupted repair) for all 12 positions (both right and left hips; 15 unique male and 14 unique female positions). Instability risk was defined as greater than 0° hip extension, greater than 30° external rotation (ER), or greater than 30° abduction. Impingement risk was defined as greater than 90° hip flexion, greater than 10° internal rotation, and greater than 10° adduction.

OUTCOMES

A majority of both male and female sexual positions caused either instability or impingement, with only 4 positions in women and 4 positions in men deemed "safe" by avoiding excessive hip motion.

RESULTS

Return to sexual activity after hip arthroscopy may cause instability in 10/15 of male positions and 5/14 female positions. Most male positions (6/10) were at risk for instability because of excessive ER. 2 positions were unstable because of a combination of ER and extension, one was due to extension, and one abduction. In female instability positions, all 5 were unstable because of excessive abduction. Impingement may be observed in 5 of 15 male positions and 6 of 14 female positions. In male impingement positions, all were due to excessive adduction. 4 female positions risked impingement due to excessive flexion and 2 positions due to internal rotation.

CLINICAL IMPLICATIONS

This study demonstrates risks that should be considered when counseling patients preoperatively and postoperatively regarding sexual activity.

STRENGTHS & LIMITATIONS

This study closely models a hip preservation patient population by using 2 young and otherwise healthy individuals. The most significant limitation of this investigation was its basis with only 2 young healthy volunteers (one male, one female) in a single motion capture session using surface-based spherical retroreflective markers from a previous investigation.

CONCLUSION

After hip arthroscopy, patients need to be made aware of the possibility of hip instability (10 of 15 men; 5 of 14 women) and impingement (5 of 15 men; 6 of 14 women) due to excessive hip motion that may compromise their outcome. Morehouse H, Sochacki KR, Nho SJ, et al. Gender-Specific Sexual Activity After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Position Matters. J Sex Med 2020;17:658-664.

The impact of acetabular labral tears on sexual activity in women

A healthy sex-life is an important component of a good quality of life. However, sexual function may be inhibited in women with acetabular labral tears because of the labrum being caught between the femoral head neck junction and the acetabular rim during flexion and/or abduction of the hip. The aim of this article is to quantify the effect that acetabular labral tears may have on the sexual lives of women and to establish the extent to which they may be expected to resolve after arthroscopic intervention. The article also highlights the importance of including questions related to the impact on sexual activity as a routine part of our taking history for a young adult with hip pain, to gain a true appreciation of the impact the symptoms have on the day-to-day lives of our patients.

Total hip arthroplasty and sexual activity: a systematic review

Hip discomfort due to degenerative pathologies causes limitations in the everyday activities of patients, including sexual activity. To address such limitations, patients are usually treated with total hip arthroplasty (THA). The aim of this systematic review was to investigate the success of this surgical procedure to ameliorate sexual activity of patients. We performed a comprehensive research of four electronic databases for articles pertaining to the benefits of THA on sexual activity. Exclusion criteria included articles not in English. The search initially yielded 34 articles. Two authors subsequently read all abstracts and excluded all studies unrelated to the topic, leaving 16 articles for further evaluation. Sixteen articles filtered by orthopaedic departments were included in this review. A total of 2391 patients were considered. Pre- and postoperative reports on sexual concerns have been evaluated and compared. The current literature suggests that sexual life is improved after THA. Patient education regarding postoperative expectations and resumption of sexual activity is severely lacking and the majority of surgeons offer little or no information on the subject. Specifically designed studies on the subject are required to evaluate the effects of surgery and approaches on postoperative restrictions.

The envelope of active hip motion in different sporting, recreational, and daily-living activities: A systematic review

BACKGROUND

In treating patients with limitations of hip motion, it is generally assumed that correction of bony morphology will provide the patient with the joint motion required to resume their activities. However, the positions of impingement and the specific excursions of joint motion required by each sport may vary. This systematic review aimed to define the envelope of active hip joint motion for participation in different sporting, recreational, and daily-living activities.

METHODS

The EMBASE, PubMed, Google Scholar, and Cochrane databases were searched to identify studies that reported kinematics of the hip in sporting, recreational, and daily-living activities. Inclusion criteria were (1) peer-reviewed articles reporting hip kinematics in a certain type of activity, and (2) presented in English. To synthesize the kinematic data, the peak values of kinematic components (i.e. flexion/extension, abduction/adduction, and internal/external rotation) during an activity, as well as the concurrent values in a certain phase of the activity were collected from each study.

RESULTS

A total of 67 studies met the inclusion criteria, involving 32 different types of activities. Seventeen activities required at least one component of supra-physiologic hip motion, however, there were eight different combinations of flexion/extension, abduction/adduction, and internal/external rotation observed. Specifically, three activities (sex, sitting cross-legged, and grand ecart lateral of ballet dancing) required simultaneous extreme degrees of all three components, five activities (arabesque, developpe devant right, and developpe a la seconde right of ballet dancing, picking up something, and taekwondo) required high degrees of two components, most commonly hip abduction combined with flexion or internal rotation.

SIGNIFICANCE

This review highlighted that many activities place supraphysiologic demands on hip joint motion, however, the kinematic components affected differ dramatically with the specific activity. This suggests that the demands of each patient's individual activities must be assessed before recommending or planning treatment rather than assuming that a fixed value of "normal" hip motion is applicable to all.

Changes in sexual activity of male patients with ankylosing spondylitis undergoing total hip arthroplasty

INTRODUCTION

Sexual activity is often an important component of life. To date, no studies have examined sexual activity before and after total hip arthroplasty (THA) in male patients with ankylosing spondylitis (AS). The purpose of the current study was to evaluate the effect of THA on sexual activity and to explore the most commonly reported and comfortable coital position for male AS patients with hip involvement.

METHODS

Data from 31 male AS patients who underwent THA for hip involvement were retrospectively reviewed. Information from the International Index of Erectile Function (IIEF), the Harris Hip Score (HHS) and other clinical parameters was collected and monitored over time. We compared the above-mentioned parameters before surgery and 2 years after surgery and analysed the correlation between changes on the IIEF and changes in clinical parameters.

RESULTS

The domain and total scores of the IIEF, except EF, were significantly higher after surgery than were those before surgery ( p < 0.05). There was a significant positive correlation between changes on the IIEF and improvement in flexion-extension range of motion (ROM), adduction-abduction ROM and HHS ( p < 0.05). Most patients (26/31, 83.9%) resumed sexual activity 5-12 weeks after surgery. The pre- and postoperative distributions of the most commonly reported and comfortable position were not significantly different (p > 0.05).

CONCLUSIONS

Successful THA may improve sexual activity in male AS patients with hip involvement. Changes in hip ROM show the most significant correlation with improvement in sexual activity. Resumption of sexual activity occurs within 5-12 postoperative weeks.

Changes in Sexual Function and Positions in Women With Severe Obesity After Bariatric Surgery

Introduction

Severe obesity is most effectively treated with bariatric surgery. The resulting weight loss is expected to improve a variety of obesity-related conditions, including sexual dysfunction.

Aim

To analyze changes in the sexual function of women with obesity following bariatric surgery.

Methods

A prospective study was conducted between April 2015 and April 2016 involving 62 women with obesity who underwent Roux-en-Y gastric bypass. The Female Sexual Function Index (FSFI) was used to evaluate sexual function. Sexual dysfunction was defined as an FSFI score below 26.55. Patients’ clinical and demographic data were recorded. Sexual frequency of 12 different sexual positions was also evaluated.

Main Outcome Measure

Sexual dysfunction prevalence and the frequency of sexual positions before and 6 months after surgery.

Results

The prevalence of sexual dysfunction decreased from 62% before surgery to 19% 6 months after the procedure. There was a 19.2% improvement in the mean overall FSFI score (P < .01). 6 months after surgery, the mean overall FSFI score had improved in all patients, with a statistically significant change being found in all 6 domains of the questionnaire (P < .05). There was an increase in the frequency of 3 of 12 sexual positions evaluated.

Conclusion

Sexual function in women with obesity effectively improves after bariatric surgery. Favorable changes following weight loss included a significant reduction in the prevalence of sexual dysfunction and an increase in the frequency of different sexual positions during intercourse.

Oliveira CFA, dos Santos PO, Oliveira RA, et al. Changes in sexual function and positions in women with severe obesity after bariatric surgery. Sex Med 2019;7:80–85.

Sexual Activities as Risk Factors of Rotator Cuff Lesions: A Prospective Cohort Study

The aim of this study was to analyze the occurrence of rotator cuff impingement due to reduction of subacromial space height during complex shoulder motion to determine safety of sexual activities. The hypothesis was that such activities could be deleterious if not performed with precaution. To use a patient-specific 3D measurement technique coupling medical imaging and optical motion capture to evaluate the safety of various sexual positions according to subacromial compression. Descriptive laboratory study. A volunteer couple underwent Magnetic Resonance Imaging (MRI) and motion capture of their shoulders. Five common active and passive sexual positions were evaluated. Significant differences in subacromial space height were observed between the different performed actions. All active sexual positions requiring important pressure on the hands or elbows (e.g., scorpio) or weight lifting (e.g., superman) caused subacromial impingement. No subacromial impingement was however observed during passive sexual activities (e.g., basset hound). This study indicates that some sexual positions could potentially place the rotator cuff at risk. Such high-tech investigation shows promise in the areas of cause, intervention and education. The present findings may assist health professionals in providing them with preventive measures and is highly relevant for decision-making regarding health promoting initiatives.

The Risk of Impingement With Sexual Activity in Femoroacetabular Impingement Syndrome Due to Cam Morphology: Shape Matters

Background:

Sexual difficulties and dysfunction are common in patients with femoroacetabular impingement syndrome (FAIS) secondary to hip pain and stiffness.

Purpose:

To determine the risk of impingement in patients with FAIS during common sexual positions using 3-dimensional computer-simulated collision detection before and after cam correction.

Study Design:

Descriptive laboratory study.

Methods:

Ten computed tomography scans of the pelvis and femur from patients with FAIS due to isolated cam morphology were retrospectively reviewed. Three-dimensional osseous models were developed using Mimics software. The cam deformity was then completely corrected. Simulations of hip range of motion for the most common sexual positions for men (n = 15) and women (n = 14) were conducted before and after cam resection. Impingement was determined for each sexual position. Position safety was defined as ≤20% of models demonstrating impingement in a position. Descriptive and simple comparative statistics were calculated.

Results:

There was no sexual position that was impingement free in all models before cam correction. After cam correction, 11 (37.9%) of 29 total positions were impingement free. There was a significant decrease in impingement from before to after cam correction (40.7% vs 11.4%, respectively, of all female positions [P < .0001]; 26.0% vs 6.7%, respectively, of all male positions [P < .0001]). There was a significant increase in the number of “safe” positions from before to after cam correction (4 vs 11, respectively, of all female positions [P = .008]; 7 vs 15, respectively, of all male positions [P = .001]).

Conclusion:

After cam correction, there was a significant reduction in the impingement rate and a significant increase in the number of “safe” sexual positions.

Clinical Relevance:

Impingement in patients with cam morphology is common during sexual activity. Surgical correction of cam morphology significantly reduces the rate of impingement. Although this laboratory imaging-only study did not account for patient symptoms, this likely translates to significant symptomatic improvement during sexual activity after surgical cam correction.

Indirect Measurement of Ground Reaction Forces and Moments by Means of Wearable Inertial Sensors: A Systematic Review

In the last few years, estimating ground reaction forces by means of wearable sensors has come to be a challenging research topic paving the way to kinetic analysis and sport performance testing outside of labs. One possible approach involves estimating the ground reaction forces from kinematic data obtained by inertial measurement units (IMUs) worn by the subject. As estimating kinetic quantities from kinematic data is not an easy task, several models and protocols have been developed over the years. Non-wearable sensors, such as optoelectronic systems along with force platforms, remain the most accurate systems to record motion. In this review, we identified, selected and categorized the methodologies for estimating the ground reaction forces from IMUs as proposed across the years. Scopus, Google Scholar, IEEE Xplore, and PubMed databases were interrogated on the topic of Ground Reaction Forces estimation based on kinematic data obtained by IMUs. The identified papers were classified according to the methodology proposed: (i) methods based on direct modelling; (ii) methods based on machine learning. The methods based on direct modelling were further classified according to the task studied (walking, running, jumping, etc.). Finally, we comparatively examined the methods in order to identify the most reliable approaches for the implementation of a ground reaction force estimator based on IMU data.

Does total joint arthroplasty impair erectile function?

INTRODUCTION

Sexuality is an important factor in quality of life (QoL) and was reported to improve after total joint arthroplasty (TJA). However, one study group found evidence regarding a high rate of impaired erectile function of about 20% in male patients after TJA. As erectile dysfunction is a serious matter of concern and there are no data explaining this observation sufficiently, the purpose of this study was to revaluate the erectile function in patients after TJA.

MATERIAL AND METHODS

All consecutive male patients scheduled for TJA were enrolled in this prospective study. Evaluation was performed pre- and 6 months postoperatively with the International Index of Erectile Function (IIEF-5) questionnaire. One hundred and fifty-nine patients fulfilled the inclusion criteria, and 51 patients wished not to take part in the study.

RESULTS

From the 108 patients who were included prior to surgery, 101 (94%) were available at the 6-month follow-up. In those patients, the preoperative erectile function was normal in 38 (24.0 ±1.1), impaired in 45 (14.7 ±6.5) and with no function in 18 patients. No significant difference in the pre- (15.4 ±9.3) and postoperative (15.3±9.2) IIEF-5 score was observed (p = 0.59) in the total group. Similarly, subgroup analysis revealed no significant difference in patients with total hip arthroplasty (p = 0.58), total knee arthroplasty (p = 0.37) or > 70 years (p = 0.08).

CONCLUSIONS

The previously reported high rate of impaired erectile function after TJA of the lower extremity could not be confirmed. Total joint arthroplasty remains a safe procedure in terms of postoperative erectile function.

Safe Positioning for Sexual Intercourse After Proximal Femoral Replacement

Hip arthroplasty is a common procedure used for the treatment of fractures and degenerative processes affecting the hip. Proximal femoral replacement is an uncommon type of hip arthroplasty used for reconstruction after extensive bone loss. Proximal femoral replacement is used most commonly after the resection of the proximal femur for malignancies and for extensive bone loss encountered in revision hip arthroplasty and occasionally for extensive bone loss after fractures. The authors present a case of a female patient who sustained a prosthetic dislocation of her proximal femoral replacement during sexual intercourse. Standard hip arthroplasty itself can pose a risk factor for dislocation associated with certain sexual positions. Proximal femoral replacement surgery likely carries an increased risk for dislocation, given the magnitude of soft tissue loss at the time of resection. The authors believe that routine perioperative conversations for sexually active patients with proximal femur replacements should include this potential risk and discuss appropriate positioning to prevent a potential dislocation. [Orthopedics. 2018; 41(2):e292-e294.].

Adventure sports and sexual freedom hip replacement: the tripolar hip

Certain athletic activities and lifestyles require a completely stable and very mobile hip. Total hip replacement with a natural femoral head size and two mobile-bearing surfaces (i.e., a "tripolar" prosthesis) is the most stable prosthesis. Elegant design and wear-resistant bearing surfaces are the keys to long-term implant survivorship. The hypothesis is that a ceramic-coated tripolar prosthesis using highly cross-linked polyethylene can provide full function and complete stability with low wear. This study sought to determine: (1) patient-reported outcomes, (2) functional outcomes, (3) implant survivorship and complications, and (4) postoperative sexual limitations. Between 1998 and 2011, the author performed 160 primary total hip replacements using tripolar prostheses in patients participating in adventure sports and other physically demanding activities. The institutional review board approved this study. The inclusion criteria were patients who needed unrestricted activity and who were not candidates for or did not choose hip resurfacing. Patients were followed every second year and assessed with radiographs, Harris Hip Score, WOMAC, SF-12, and UCLA functional outcome scores. Patients were asked about symptoms of instability and satisfaction with their hip replacement. Patients were asked both preoperatively and 2 years postoperatively four questions about their sexual activity. Mean follow-up was 11 years. At 2 years' postoperatively, 98% of patients reported their satisfaction as excellent or good and 99% were not limited for sexual activity following surgery. Seventy-four percent of patients reported they were recovered within 6 weeks of surgery. There were no dislocations. There were three revision procedures for implant loosening, infection, and periprosthetic fracture, but there were no failures of the tripolar articulation. The mean postoperative UCLA score was the highly athletic score of 8. There were no signs of osteolysis, wear, or metal sensitivity reactions. The range of motion achieved, sexual, and functional outcomes were higher than with other types of total hip replacement. This ceramic-coated tripolar prosthesis using highly cross-linked polyethylene provides full function, complete stability, and low wear to younger, active patients, thus confirming the hypothesis and clinical relevance.

Patient sexual function and hip replacement surgery: A survey of surgeon attitudes

PURPOSE

To explore practises of orthopaedic surgeons (and residents) in addressing sexual function (SF) in patients before and after total hip arthroplasty (THA).

METHODS

A 26-item questionnaire was sent to health professionals (n = 849); 526 (62.0%) responses were included in the analyses.

RESULTS

About 78% of the respondents (77.5%) almost never addressed SF. The most mentioned reason was that "patients do not ask" (47.4%) followed by "I am not aware of possible needs" (38.6%). SF was even less discussed (25.9%) in elderly patients (>60 years). The beneficial effect of THA on SF was rated the highest in retired surgeons (p ≤ 0.001), in which male surgeons scored higher than female surgeons (p = 0.002). The importance of sexual dificulties (SD) in the decision to undergo surgery was rated lowest by residents (p = 0.020). Rating the risk for dislocation varied between occupations (p = 0.008) and gender (p = 0.016), female surgeons rated highest (median 5); 54.1% indicated the orthopaedic surgeon is responsible for providing information about the safe resumption of sexual activity.

CONCLUSIONS

Surgeons show little attention to SF related issues in THA patients, which seems not in accordance to patients' needs. Addressing SF increases throughout a surgeon's career. There were divergent views and there is no "common advice" about the safe resumption of sexual activity. The results emphasize the need for guidelines and training in order to encourage addressing SF both, before and after THA.

Improvements in Sexual Activity After Total Knee Arthroplasty

BACKGROUND

Sexual limitations in the setting of total knee arthroplasty (TKA) are poorly understood.

METHODS

Surveys were designed to assess preoperative and postoperative sexual function, and limitations were retrospectively administered to 91 sexually active TKA patients at an average of 2.1 years (range, 0.5-4.0) after surgery. Preoperative and postoperative responses were compared using 1-tailed and 2-proportion z tests, with P < .05 as the threshold for significance.

RESULTS

Before TKA, sexual quality and/or frequency was limited in 45% of patients because of their knee. Patients experienced an average 17.1 months (range, 0-60) of sexual limitations before surgery, resulting largely from pain (87%) and diminished range of motion or flexibility (44%). Fifty-five percent of patients reported the need to change their sexual positions to accommodate their knee, with 97% of these patients indicating the need to avoid kneeling during sex. Postoperatively, fewer patients had to adjust their sexual positions to accommodate their knee (55% vs 28%, P = .0005), and avoid bearing weight on the afflicted knee during sex (97% vs 79%, P = .0213). Patients resumed sexual activity after an average of 2.4 months (range, 0-18). Despite these general improvements, 25% of individuals had less sex in the first year after surgery. After 1 year of recovery, however, 60% indicated that they more easily engaged in sexual activity than in the previous year, with 84% of these patients experiencing less pain, and 30% experiencing greater mobility or range of motion.

CONCLUSION

TKA does not eliminate sexual limitations, but it significantly decreases kneeling dysfunction and gives patients more liberty in selecting their sexual positions.

Hips, Knees, and Hernia Mesh: When Does Gender Matter in Surgery?

This paper draws attention to gendered dimensions of surgical device failure, focusing on two case studies—hernia repair mesh for pelvic organ prolapse, and metal-on-metal hip implants. We explore possible reasons for higher rates of harms to women, including systematic biases in health research and device regulation. Given that these factors are readily identifiable, we look to feminist scholarship to understand what might maintain them, including the role of cultural factors within surgery, such as gendered communication patterns and sexism. We then canvas potential measures to mitigate the increased risk of harms faced by women who use implanted devices.

Sexual Activity After Total Hip Arthroplasty: A Systematic Review of the Outcomes

BACKGROUND

Total hip arthroplasty (THA) may have a marked positive impact on sexual activity. However, it is unclear how important regaining sexual activity is for patients undergoing THA or whether surgeons are aware of such concerns. The purpose of this systematic review was to evaluate the literature on the effect of THA on sexual activity before and after the procedure and to assess patient and surgeon perspectives.

METHODS

A search of 4 electronic databases yielded 10 reports between 1970 and 2015. Nine evaluated the effects of THA on sexual activity in 1694 patients who had a mean age of 57 years (range 17-98 years). Two studies evaluated the perspective of 337 surgeons. Metrics evaluated included differences in patient and surgeon perspectives, improvements in sexual activity, and differences in outcomes between men and women.

RESULTS

Seventy-six percent of patients identified hip arthritis as the primary cause of sexual problems with pain and stiffness being the most common complaints. Post THA, 44% of patients reported improvements in sexual satisfaction while 27% reported increased intercourse frequency. Patients returned to sexual activity at a mean 4-month post-THA. Eighty-six percent of surgeons rarely or never discuss sexual activity with their patients, and 61% believed that patients can resume sexual activity 1-month post-THA with many agreeing that certain positions were safer.

CONCLUSION

The outcomes of this systematic review suggest that THA is associated with improved sexual activities and is an important topic for patients. However, surgeons may spend less time than is desired by the patients on this subject pre- and post-THA.

Changes in Sexual Activity in Male Patients Surgically Treated for Kyphosis due to Ankylosing Spondylitis

STUDY DESIGN

A retrospective study.

OBJECTIVE

The aim of this study was to assess the changes in sexual activities in male patients surgically treated for ankylosing spondylitis (AS)-induced kyphosis and the correlation between these changes and spinal sagittal realignment.

SUMMARY OF BACKGROUND DATA

Sexual function may be affected by AS. However, little is known about the effect of spinal surgery on the sexual activity of patients with AS-induced kyphosis.

METHODS

Data of 45 male patients who had been surgically treated for AS-induced kyphosis were retrospectively reviewed. Changes in sexual activity were evaluated by the international index of erectile function (IIEF), frequency of sexual activity, and time point at which sexual activity began postoperatively. We compared the above-mentioned parameters before and 24 months postoperatively and analyzed the correlation of the changes in the IIEF with the changes in radiological characteristics.

RESULTS

Each domain of the IIEF and the total IIEF were increased postoperatively. Improved sexual function was correlated with changes in spinal sagittal characteristics, among which lumbar lordosis (LL) and the chin-brow vertical angle (CBVA) were the most significant causes (P < 0.05). Most patients (71.1%) resumed their sexual activity 5 to 12 weeks after surgery. At the 24-month follow-up, the frequency of patients' sexual activity was higher than that before surgery (P < 0.05).

CONCLUSION

Surgical correction of spinal deformity may improve sexual function and increase the frequency of sexual activity in men with AS. Spinal sagittal realignment and pelvic rotation may be correlated with improvement of sexual function.

LEVEL OF EVIDENCE

4.

Does total hip replacement affect sexual quality of life?

Background

Total Hip Replacement (THR) is an effective treatment for end-stage hip osteoarthritis. Since the introduction of total joint replacement, the effect on the Sexual Quality of Life (SQoL) following THR has been addressed in scant studies. The aim of our study was to systematically review the literature, to summarise effects of THR on patients’ SQoL.

Methods

We searched PubMed, EMBASE and PsycINFO between January 1970 and February 9th, 2015 with search terms including Total Hip, Osteoarthritis, SQoL, and THR. Eligible studies were identified and two independent authors extracted data including details of SQoL, study quality and risk of bias.

Results

There were 12 eligible studies, which included a total of 2099 patients with an age range of 20–85 years. The methodological quality of ten studies was rated as low, and of two as moderate. Amongst the majority of patients, SQoL improved after surgery, both in terms of physical-functional and psychosocial well-being. However, changes between pre-operative and postoperative SQoL ranged extensively: for example, Sexual Dysfunction Δ 8–51 % and Sexual Activity (SA) Δ 0–77 %. Three studies reported that some patients never resumed SA again after surgery.

Conclusion

In over 40 years of THR treatment, scant studies have examined the effect of THR on patients’ SQoL. This review suggests that SQol improves after THR, although the magnitude of effects varies highly. However, the quality of the supporting evidence was rated as low to moderate. This suggests a need for more high quality evidence about the effects of THR on SQoL.

High Rates of Interest in Sex in Patients With Hip Arthritis

BACKGROUND

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.

QUESTION/PURPOSES

(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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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 OF EVIDENCE

Level III, prognostic study.

Analysis of hip range of motion in everyday life: a pilot study

Patients undergoing total hip arthroplasty are increasingly younger and have a higher demand concerning hip range of motion. To date, there is no clear consensus as to the amplitude of the "normal hip" in everyday life. It is also unknown if the physical examination is an accurate test for setting the values of true hip motion. The purpose of this study was: 1) to precisely determine the necessary hip joint mobility for everyday tasks in young active subjects to be used in computer simulations of prosthetic models in order to evaluate impingement and instability during their practice; 2) to assess the accuracy of passive hip range of motion measurements during clinical examination. A total of 4 healthy volunteers underwent Magnetic Resonance Imaging and 2 motion capture experiments. During experiment 1, routine activities were recorded and applied to prosthetic hip 3D models including nine cup configurations. During experiment 2, a clinical examination was performed, while the motion of the subjects was simultaneously captured. Important hip flexion (mean range 95°-107°) was measured during daily activities that could expose the prosthetic hip to impingement and instability. The error made by the clinicians during physical examination varied in the range of ±10°, except for flexion and abduction where the error was higher. This study provides useful information for the surgical planning to help restore hip mobility and stability, when dealing with young active patients. The physical examination seems to be a precise method for determining passive hip motion, if care is taken to stabilise the pelvis during hip flexion and abduction.

Evaluation of Sexual Function Before and After Hip Arthroscopic Surgery for Symptomatic Femoroacetabular Impingement

BACKGROUND

It is unknown if chronic hip pain due to femoroacetabular impingement (FAI) may cause sexual difficulties. Available evidence suggests that hip arthroscopic surgery may be effective for the treatment of symptomatic FAI; however, sexual function before and after hip arthroscopic surgery has not been reported.

PURPOSE/HYPOTHESIS

The purpose of this study was to determine the presence and significance of sexual difficulties in patients with chronic hip pain due to symptomatic FAI both before and after hip arthroscopic surgery. The hypotheses were that (1) chronic hip pain due to symptomatic FAI has a negative effect on sexual function, (2) hip arthroscopic surgery improves the level of sexual function postoperatively, (3) the characteristics of sexual difficulties may be dependent on sex or age, (4) patients lack knowledge of potential sexual activity changes in the preoperative and postoperative periods, and (5) patients desire a greater level of discussion regarding potential changes in sexual function.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A 23-item Likert-style questionnaire assessing preoperative and postoperative sexual function and a modified Harris Hip Score questionnaire were administered to 305 consecutive patients who underwent hip arthroscopic surgery for FAI with a minimum 1-year follow-up. Comparative analysis was performed between sexes and age groups (young: <40 years; old: >40 years).

RESULTS

Of 131 respondents, preoperative sexual difficulties were reported by 66%, occurring 30.8 ± 49.1 days after the onset of FAI symptoms. Primary causes of difficulty included pain (77.9%), stiffness (47.1%), and loss of interest (21.4%). Sexual activity resumed 29.2 ± 20.1 days postoperatively, while sex with minimal pain occurred at 48.8 ± 40.6 days. Female patients and older patients (>40 years old) resumed sexual activity later (female: 34.8 ± 23.2 days; male: 21.0 ± 10.7 days; P < .0001) (young: 26.3 ± 21.7 days; old: 35.7 ± 13.5 days; P = .017). The frequency of sexual activity increased in 32.3%, decreased in 16.9%, and was unchanged in 48.5%. Among patients who reported an increase in the frequency of sexual activity, there was a greater proportion of male patients and younger patients (female: 38.1%; male: 61.9%; P < .0001) (young: 78.6%; old: 21.4%; P < .0001). More female patients reported alterations in sexual positioning (female: 82.3%; male: 17.7%; P < .0001). To obtain information on sexual function, 77.4% of patients preferred a discussion with the surgeon, and 67.4% preferred a booklet on the subject. Relief of pain after arthroscopic surgery was experienced by 88.9%, and only 10.8% reported current sexual difficulties.

CONCLUSION

This study demonstrates the prevalence of sexual difficulties among the majority of patients with symptomatic FAI, the significant effect that these difficulties may have on quality of life, and the ability of hip arthroscopic surgery to improve sexual function postoperatively. While further studies are required to elucidate what specific factors are associated with sexual difficulties, the current study suggests that this is an important topic to explore.

Three-dimensional virtual simulation and evaluation of the femoroacetabular impingement based on "black bone" MRA

INTRODUCTION

Femoroacetabular impingement (FAI) is a recognised cause of secondary osteoarthritis of the hip. Several imaging methods have been used to analyse the pathologic signs. Because of the lack of precise pre- and intraoperative overview and the difficulty locating osseous pathologies, arthroscopic and minimal invasive treatment is still challenging, even for trained surgeons. This paper describes a procedure that is based on magnetic resonance arthrography (MRA) and is used to virtually verify the range of motion (ROM) of the hip. It enables the evaluation of FAI and the preoperative simulation of adequate surgical manoeuvres.

METHODS

Each MRI was completed on a 3.0 T system using a flexible transmit/receive surface body coil with the patient in the supine position. An axial three-dimensional (3D) gradient-echo (VIBE, volume interpolated breathhold examination) sequence was performed. For the generation of 3D bone models, semiautomatic segmentation of the MRA data was accomplished using Amira(®) visualisation software version 5.2. The self-developed software "HipProject", written in C++, computes the maximal ROM of the hip. The virtual colliding regions were visualised for verification and simulation of osseous trimming.

RESULTS

In addition, for necessary information about damage to the cartilage and labrum, "black bone" MRA was used to generate extremely precise 3D reconstructions of the hip joint to automatically calculate the preoperative osseous ROM. Furthermore, the acetabular and femoral locations of the impingement zone were individually visualised and quantified.

CONCLUSIONS

The described procedure is a useful tool for the preoperative investigation of impinging hips. It enables appropriate planning of required surgical interventions.

MyHip: supporting planning and surgical guidance for a better total hip arthroplasty : A pilot study

PURPOSE

Total hip arthroplasty (THA) aims to restore patient mobility by providing a pain-free and stable artificial joint. A successful THA depends on the planning and its execution during surgery. Both tasks rely on the experience of the surgeon to understand the complex biomechanical behavior of the hip. We investigate the hypothesis that a computer-assisted solution for THA effectively supports the preparation and execution of the planning.

METHODS

We devised MyHip as a computer-assisted framework for THA. The framework provides pre-operative planning based on medical imaging and optical motion capture to optimally select and position the implant. The planning considers the morphology and range of motion of the patient's hip to reduce the risk of impingements and joint instability. The framework also provides intra-operative support based on patient-specific surgical guides. We performed a post-operative analysis on three patients who underwent THA. Based on post-operative radiological images, we reconstructed a patient-specific model of the prosthetic hip to compare planned and effective positioning of the implants.

RESULTS

When the guides were used, we measured non-significant variations of planned executions such as bone cutting. Moreover, patients' hip motions were acquired and used in a dynamic simulation of the prosthetic hip. Conflicts prone to implant failure, such as impingements or subluxations, were not detected.

CONCLUSIONS

The results show that MyHip provides a promising computer assistance for THA. The results of the dynamic simulation highlighted the quality of the surgery and especially of its planning. The planning was properly executed since non-significant variations were detected during the radiological analysis.

Sexual Function before and after Total Hip Replacement: Narrative Review

Background

More than 1 million total hip replacements (THRs) are performed every year worldwide. Achieving decreased pain, increased mobility, and improved quality of life (QoL) are key factors in the decision to undergo THR. Sexual activity is a valued component of QoL; however, little is known about how THR affects sexual functioning or the extent to which health care providers address sexuality in THR patients.

Aim

The aim of the study was to assess the literature regarding sexuality and sexual function in patients before and after THR.

Methods

PubMed, Google Scholar, and PEDro databases were searched without search limitations from inception until December 2013 for terms relating to sexual function and THR.

Results

Sexual activity before and after a THR is an important QoL issue. In patients with end-stage hip osteoarthritis, THR has been reported to have beneficial effects in restoring sexual satisfaction and performance. While research has recently been conducted to determine the range of motion of the hip joints necessary to execute certain sexual positions, there remains a lack of validated guidelines and the risks related to sexual activity after THR is rarely discussed between patients and medical staff.

Conclusions

The ability to move comfortably is included among the many physical and psychosocial factors influencing sexual functioning. Practitioners should be encouraged to question their THR patients about sexual concerns and to provide counseling related to physical and functional aspects of sexual activity. Rehabilitation that focuses specifically on activities of daily living of sex should include sexual counseling, therapeutic exercise, and advice regarding sexual positions. Rehabilitation provided by physical therapists may help decrease pain, and facilitate greater self-awareness, self-confidence, and improved body image, all of which encourage and affirm optimal sexual health. Meiri R, Rosenbaum TY, and Kalichman L. Sexual function before and after total hip replacement: Narrative review.