The impact of total joint arthroplasty on sexual function in young, active patients

The Effects of Sexual Education on Function and 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).

METHODS

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 4 times throughout the study: preoperatively, at 1, 3, and 6 months after surgery. The data were collected by using the sociodemographic and medical data form, the Index of Female Sexual Function, the Sexual Quality of Life-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% confidence interval [Cl] [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% CI [-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% CI [5.23 to 35.79]) follow-ups (P < 0.05). For the 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 Index of Female Sexual Function score, it was found that the change over time was significantly different for both groups (F = 69.64, P < 0.05).

CONCLUSIONS

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

Association Between Digitally Provided Education and 90-Day Return to Sexual Activity Following Total Knee Arthroplasty: A Randomized Controlled Trial

BACKGROUND

Contemporary total knee arthroplasty patients have increased expectations of returning to predisease function, including sexual activity (SA). The purpose of this study was to determine whether patients using a digital care management platform (DCMP) were more likely to have a higher rate and frequency of return to SA.

METHODS

We conducted an exploratory analysis of a prospective, multicenter, randomized controlled trial that enrolled patients undergoing total knee arthroplasty. A total of 304 patients were randomized to a DCMP (n = 119) providing preoperative and postoperative education regarding return to SA or standard postoperative care (control group; n = 185). Return to SA, assessed via questionnaire, patient-reported outcome measures, Timed Up and Go test, single leg stance, active range of motion and need for manipulation under anesthesia were assessed at 90 days postoperatively.

RESULTS

More patients in the DCMP group returned to SA compared to control at 90 days (58.4 versus 39.6%, P = .018); however, the control group resumed SA sooner (33.1 versus 42.0 days, P = .023). Patients who returned to SA were younger (61.6 versus 65.9 year), more often men (56 versus 35%) (P < .001), higher performing on the Timed Up and Go and single leg stance tests (P < .001), and had greater active range of motion (P = .007). There were no differences in patient-reported outcome measures or need for manipulation under anesthesia between patients that returned to SA and those who did not.

CONCLUSIONS

More patients using a DCMP resumed SA at 90 days; however, patients in the control group returned to SA sooner. Those who returned to SA were younger, possessed greater physical function, and were more often men.

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.

Sexual function and sexual activity in young total hip arthroplasty Chinese patients: A retrospective cohort study

Introduction

As an essential component of quality of life, there is limited evidence of sexual function (SF), especially for young patients, before and after total hip arthroplasty (THA). This study aims to enhance the understanding of SF status and assess patient perspectives before and after THA.

Methods

A total of 109 patients who received THA were enrolled into our retrospective cohort study. To assess the SF status before and after THA, patients were required to fill out a standardized SF questionnaire [female sexual function index (FSFI) or brief sexual function inventory (BSFI) for males] and a specifically designated questionnaire regarding perspectives toward sexual activity and attitudes to sexual-related information.

Results

Total average scores of both FSFI and BSFI were higher post-THA. For female patients, the FSFI scores were significantly higher in the domain of desire, orgasm, and satisfaction (p < 0.05). For male patients, the BSFI scores were also improved in the sex drive and satisfaction domain post-operation (p < 0.05). A large proportion of the patients (64.22%) reported difficulty in sexual activity preoperatively, primarily due to restricted motion (82.86%) and hip pain (74.29%). After a successful procedure, there was a reduction in difficulty in patients' sexual activity post-THA (39.45%), mainly attributed to less pain (72.09%) and greater mobility (79.07%). In addition, subgroup analysis results indicated that gender and severity of hip stiffness and pain were crucial factors that could affect the patient's SF status. Furthermore, the majority of patients reported that they desired information concerning sexual activity, but only 12.84% of patients were informed well. Patients' preferred channels to acquire sexual-related information was a booklet (65.59%, n = 61), followed by informing a surgeon and a nurse. The most concerning questions regarding the sexual activity of patients were the time to recovery (90.32%) and safe postures (76.34%).

Conclusion

The majority of men and women who underwent THA reported their SF status return to baseline or have improved, mainly attributable to less pain and greater mobility. Age and severity of hip pain/stiffness were the factors that could affect patients' SF status. Sexual education for young THA patients is needed due to the lack of related information during hospitalization.

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.

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.

Improvements in sexual function following arthroscopic rotator cuff repair

BACKGROUND

Three-fourths of Americans are sexually active, and studies show a correlation between sexual activity and good health. Rotator cuff tears and subsequent repairs can cause significant disruption in daily living including sexual activity. Orthopedic surgeons rarely discuss sexual activity with patients. Therefore, patients have little information about expectations, restrictions, and return to sexual activity. The primary goal of this study was to evaluate patient improvement in sexual activity following arthroscopic rotator cuff repair and evaluate factors that affect sexual activity.

METHODS

An anonymous 20-item multiple-choice survey was sent to patients > 6 months after arthroscopic rotator cuff repair performed by 7 fellowship-trained orthopedic shoulder and elbow surgeons between March 2018 and May 2019. The survey assessed preoperative and postoperative sexual activity and included questions regarding frequency, pain, positioning, and postoperative injury.

RESULTS

A total of 88 patients met the inclusion criteria and completed the survey. Preoperatively, 65% of patients admitted that their shoulder interfered with the quality and/or frequency of their sexual activity, most commonly secondary to an inability to bear weight on the affected arm (31%). Postoperatively, the majority of patients (79%) found it easier to engage in sexual activity, with 35% of patients attributing this to less pain. At 6 weeks postoperatively, 72% of patients returned to sexual activity. The overall trend demonstrated a statistically significant (P < .001) increase in sexual activity frequency as one progressed from his or her operative date. It is interesting to note that 31% of patients removed their sling to engage in sexual activity after surgery, with 7% admitting to aggravating their shoulder or causing significant pain.

CONCLUSION

Prior to arthroscopic rotator cuff repair, most patients experience limitations in the quality and/or frequency of their sexual activity secondary to their shoulder. Following surgery, the majority of patients will more easily engage in sexual activity by 6 weeks, with increasing frequency as time progresses from surgery. Many patients are noncompliant with sling wear during sexual activity, and 7% will aggravate their shoulder.

Complex patellofemoral reconstruction leads to improved physical and sexual activity in female patients suffering from chronic patellofemoral instability

PURPOSE

To analyze postoperative physical and sexual activity as well as Quality of Life (QoL) after complex patellofemoral reconstructions in female patients suffering from chronic patellofemoral instability (PFI).

METHODS

Female patients aged > 18 years undergoing complex patellofemoral reconstruction for chronic PFI were included. Complex patellofemoral reconstruction was defined as medial patellofemoral ligament reconstruction (MPFL-R) combined with at least one major bony procedure (distal femoral osteotomy, high tibial osteotomy, and trochleoplasty). Outcome was evaluated retrospectively after a minimum follow-up of 12 months using Tegner activity scale, Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0), EuroQol-5D-3L (EQ-5D-3L), EuroQol Visual analog scale (EQ-VAS), and a questionnaire about sexual activity.

RESULTS

A total of 34 females (mean age, 26 ± 5 years) with a mean follow-up of 45 ± 16 months were included. Seventy-seven percent had one major bony correction + MPFL-R and 24% had at least two major bony corrections + MPFL-R. The re-dislocation rate was 6%. Median Tegner activity scale improved from 3 (range 0-10) to 4 (range 2-6) (n.s.) and an improved activity level was observed in 49% of subjects. QoL scores showed an EQ-5D-3L Index Value of 0.89 ± 0.15, EQ-VAS of 80.3 ± 11.4, and BPII of 68.3 ± 19.1. Thirty-four percent of patients reported restrictions of sexual activities due to PFI preoperatively with an improved sexual function observed in 60% postoperatively due to less pain, improved mobility, and less apprehension. Postoperative return to sexual activity was 91%, whereof 19% reported current restrictions of sexual function because of pain and/or limited range of motion.

CONCLUSION

Despite the complexity and invasiveness of complex patellofemoral reconstruction, combined bony procedures and MPFL-R resulted in a low redislocation rate, improved physical activity and QoL comparable to values reported after isolated MPFL-R. Furthermore, sexual activity was improved in 60% of females with preoperative restrictions.

LEVEL OF EVIDENCE

IV.

A High Proportion of Patients Have Unfulfilled Sexual Expectations After TKA: A Prospective Study

BACKGROUND

Most patients have high expectations about restoration of the knee function after TKA, expecting a more active life after retirement. However, 20% to 30% of patients report that their expectations are not met postoperatively. Among those unmet expectations may be the anticipation to engage in sexual activity after surgery, but few studies have evaluated sexual activity after arthroplasty.

QUESTIONS/PURPOSES

In this study, our purposes were (1) to evaluate the anticipation and the fulfillment of sexual activity after TKA in men and women, and (2) to identify prognostic factors for the fulfillment of anticipated postoperative sexual activity.

METHODS

This was a prospective, multicenter study of all 1371 patients scheduled for TKA between June 2012 and July 2015. The study was part of the Longitudinal Leiden Orthopaedics Outcomes of Osteoarthritis Study (LOAS). After screening according to LOAS inclusion criteria, 1213 respondents remained. Our primary study endpoint was whether sexual expectations were met 1 year after TKA; we used the sexual-activity-expectation question from the Hospital for Special Surgery (HSS) Knee Replacement Expectations Survey, which allows the patient to score the result on a 5-point scale. To assess postoperative fulfillment of sexual activity 1 year after TKA, we asked the patient to score the current status of sexual activity on the same 5-point scale: 1 (back to normal), 2 (large improvement), 3 (moderate improvement), 4 (slight improvement), and 5 (does not apply). Patients with incomplete data on the preoperative expectation- and postoperative fulfillment-question of sexual activity were excluded, leaving 71% (866 of 1213) patients for analysis. The difference between the pre- and postoperative scores determined whether expectations of sexual activity were unfulfilled (lower than expected) or fulfilled/exceeded (neutral or higher than expected). Pre- and postoperatively, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Short Form-12 Mental and Physical Component Summary scores (SF-12 MCS and SF-12 PCS), the EuroQoL-5 Dimensions (EQ-5D), and the EQ-5D VAS scale were used. Multivariate regression models were used for analysis.

RESULTS

Preoperatively, 54% patients (467 of 866) anticipated postoperative sexual activity after recovery from surgery. Both genders showed that the proportion who anticipated "back to normal" sexual activity decreased with higher age. Likewise, postoperative fulfillment of anticipated sexual activity was found in 58% (111 of 191 for men; 159 of 276 for women). Younger women (younger than 65 years of age) experienced fulfillment more often compared with younger men. A positive postoperative change in functional and health status was associated with fulfilled/exceeded scores of patients anticipating postoperative sexual activity. A better preoperative health status, the EQ-5D VAS score (odds ratio [OR] 1.02 [95% CI 1.01 to 1.03]; p = 0.006), was associated with a higher likelihood of fulfillment of anticipated postoperative sexual activity.

CONCLUSION

In both men and women, two of five patients who anticipated postoperative sexual activity indicated that their expectation of sexual activity was not met 1 year after TKA. These patients had worse functional recovery scores compared with patients who achieved the anticipated level of sexual activity. The latter is associated with functional recovery. Surgeons should be aware that many patients anticipate restoration of normal sexual activity, and that this may be the expectation for patients of all ages and for women and men alike. The results underscore the need for more qualitative research to understand this topic in greater depth.

LEVEL OF EVIDENCE

Level II, therapeutic study.

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.

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

Background

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

Methods

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.

Results

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).

Conclusions

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.

Level of Evidence

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

Translation, cross-cultural adaption and validation of the French version of the Forgotten Joint Score in total hip arthroplasty

INTRODUCTION

The ability to "forget" a joint implant in everyday life is considered to be the ultimate objective in arthroplasty. Recently, a scoring system, the Forgotten Joint Score (FJS-12), was published based on a self-administered questionnaire comprising 12 questions assessing how far patients had been able to forget their hip or knee prosthesis. The main objective of the present study was to translate, adapt and assess a French-language version of the FJS-12 in total hip arthroplasty (THA) patients.

PATIENTS AND METHODS

The questionnaire was translated by 2 orthopedic surgeons and a medical physician, all bilingual, then back-translated into English by two native English-speaking translators unacquainted with the original. A concertation meeting adopted a beta-version of this Score de Hanche Oubliée (SHO-12), which was then tested on 15 randomly selected THA patients and adapted according to their comments. The final version was validated following the international COSMIN methodology. Data collection was prospective, included all patients operated on by a single surgeon using a single technique. Reference questionnaires comprised Oxford Hip Score (OHS-12) and modified Harris Hip Score (HHS). The 3 assessments were conducted with a minimum 1 year's follow-up. The SHO-12 was administered twice, with a 1-week interval. Statistical tests assessed construct validity (Pearson correlation test), internal coherence (Cronbach alpha), reliability (intraclass correlation coefficient) and feasibility (percentage missing values, administration time and ceiling and floor effects).

RESULTS

Translation/back-translation encountered no particular linguistic problems. Fifty-eight patients (63 THAs) responded to all questionnaires: 22 female, 36 male; mean age, 62.7±15.2 years. Mean follow-up was 1.6±0.4 years. SHO-12 correlated strongly with OHS-12 and HHS. Internal coherence was good (alpha=0.96) and reproducibility excellent. No floor or ceiling effects were found.

CONCLUSION

SHO-12, the French-language version of the FJS-12 in THA, is a valid, reproducible self-administered questionnaire, comparable to the English-language version.

LEVEL OF EVIDENCE

I, Testing of previously developed diagnostic criteria on consecutive patients - Diagnostic study.

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.

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.

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.

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.