1
|
Stegelmann SD, Butler JT, Hiatt JL, Bullock MW. Safe Sex After Total Hip Arthroplasty: Using Computed Tomography-Based Robotics to Evaluate "At-Risk" Sexual Positions. J Arthroplasty 2024; 39:433-440.e4. [PMID: 37572725 DOI: 10.1016/j.arth.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Justin T Butler
- Department of Orthopedic Surgery, Mercy Health Saint Vincent Medical Center, Toledo, Ohio
| | - John L Hiatt
- Department of Orthopedic Surgery, Mercy Health Saint Vincent Medical Center, Toledo, Ohio
| | - Matthew W Bullock
- Department of Orthopaedic Surgery, Marshall University, Joan C. Edwards School of Medicine, Huntington, West Virginia
| |
Collapse
|
2
|
Madden K. CORR Insights®: How Much Perioperative Pain and Dysfunction Underlie the HOOS JR and KOOS JR? Clin Orthop Relat Res 2023; 481:1811-1812. [PMID: 37083518 PMCID: PMC10427031 DOI: 10.1097/corr.0000000000002666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Kim Madden
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joseph's Healthcare, Hamilton, ON, Canada
| |
Collapse
|
3
|
Hauer G, Sadoghi P, Smolle M, Zaussinger S, Friesenbichler J, Leithner A, Maurer-Ertl W. Sexual activity after short-stem total hip arthroplasty. Does stem size matter? Arch Orthop Trauma Surg 2023; 143:3613-3619. [PMID: 36114870 PMCID: PMC10192171 DOI: 10.1007/s00402-022-04614-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/03/2022] [Indexed: 02/09/2023]
Abstract
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.
Collapse
Affiliation(s)
- Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Maria Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Sabrina Zaussinger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| |
Collapse
|
4
|
Navas L, Hauschild M, Miehlke W, Schmidt S, Streit M, Kinkel S, Zimmerer A. Length doesn't play a role - Sexual activity in men after short stem Total hip Arthroplasty. BMC Musculoskelet Disord 2022; 23:696. [PMID: 35869488 PMCID: PMC9306083 DOI: 10.1186/s12891-022-05660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Luis Navas
- ARCUS Sportklinik, Rastatterstraße 17-19, 72175, Pforzheim, Germany.
- Orthopädische Klinik Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstraße 38, 70176, Stuttgart, Germany.
| | | | - Wolfgang Miehlke
- ARCUS Sportklinik, Rastatterstraße 17-19, 72175, Pforzheim, Germany
| | | | - Marcus Streit
- ARCUS Sportklinik, Rastatterstraße 17-19, 72175, Pforzheim, Germany
| | - Stefan Kinkel
- ARCUS Sportklinik, Rastatterstraße 17-19, 72175, Pforzheim, Germany
| | - Alexander Zimmerer
- ARCUS Sportklinik, Rastatterstraße 17-19, 72175, Pforzheim, Germany
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| |
Collapse
|
5
|
Oliva-Lozano JM, Alacid F, López-Miñarro PA, Muyor JM. What Are the Physical Demands of Sexual Intercourse? A Systematic Review of the Literature. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1397-1417. [PMID: 35147835 PMCID: PMC8917001 DOI: 10.1007/s10508-021-02246-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
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.
Collapse
Affiliation(s)
- José M Oliva-Lozano
- Health Research Centre, Faculty of Educational Sciences, University of Almería, Edificio de Humanidades A, Ctra. Sacramento s/n. 04120, La Cañada de San Urbano, Almería, Spain
| | - Fernando Alacid
- Health Research Centre, Faculty of Educational Sciences, University of Almería, Edificio de Humanidades A, Ctra. Sacramento s/n. 04120, La Cañada de San Urbano, Almería, Spain
| | | | - José M Muyor
- Health Research Centre, Faculty of Educational Sciences, University of Almería, Edificio de Humanidades A, Ctra. Sacramento s/n. 04120, La Cañada de San Urbano, Almería, Spain.
- Laboratory of Kinesiology, Biomechanics and Ergonomics, Research Central Services, University of Almería, Almería, Spain.
| |
Collapse
|
6
|
Turhan S, Buyuk A. Evaluation of sexual quality of life after bilateral total hip arthroplasty surgery. Orthop Traumatol Surg Res 2022; 108:103125. [PMID: 34700057 DOI: 10.1016/j.otsr.2021.103125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/07/2021] [Accepted: 09/03/2021] [Indexed: 02/03/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sadullah Turhan
- Department of Orthopedics and Traumatology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey.
| | - Alime Buyuk
- Department of Physiotherapy and Rehabilitation Antalya, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| |
Collapse
|
7
|
Lung T, Selvam R, Sadacharam D, Grant H, Wood G. Educating Patients on Returning to Sexual Activity Following Total Hip Arthroplasty. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Fawaz WS, Masri BA. Allowed Activities After Primary Total Knee Arthroplasty and Total Hip Arthroplasty. Orthop Clin North Am 2020; 51:441-452. [PMID: 32950213 DOI: 10.1016/j.ocl.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It is essential for total knee arthroplasty patients to return to their previous level of activity to maintain a healthy lifestyle. This article reviews the current recommendations regarding return to physical activity after total knee arthroplasty and trying to find the balance between levels of activity and prosthetic joint preservation. In general, most total joint replacement patients are able to return to their previous level of activity and to a lesser extent to sports. This article discuss patients' actual levels of activity including their return to work and sport and the factors that influence meeting their expectations for surgery.
Collapse
Affiliation(s)
- Wissam S Fawaz
- Department of Orthopaedic Surgery, University of British Columbia, Complex Joint Clinic, Third Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Bassam A Masri
- Department of Orthopaedic Surgery, University of British Columbia, Complex Joint Clinic, Third Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
| |
Collapse
|
9
|
Nilsing Strid E, Ekelius-Hamping M. Experiences of sexual health in persons with hip and knee osteoarthritis: a qualitative study. BMC Musculoskelet Disord 2020; 21:576. [PMID: 32838770 PMCID: PMC7445899 DOI: 10.1186/s12891-020-03596-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background Osteoarthritis (OA) is the world’s most common form of arthritis and a common cause of musculoskeletal pain and disability. Persons living with chronic diseases often have affected sexual health because of pain and limited function. Osteoarthritis is a chronic disease but there is scarce knowledge about how sexual health is experienced. The aim of this study was to explore the experience of sexual health in persons who have seen a physiotherapist for their hip and/or knee OA. Methods This study has a qualitative design. Participants were recruited from the Swedish Quality Register Better Management of Patients with Osteoarthritis (BOA). To reach a variety of experiences and strengthen credibility, a purposeful sampling strategy based on age, sex and hip and knee OA was used. Semi-structured telephone interviews were held with 20 persons with hip and/or knee OA. Data were analysed with qualitative content analysis and inductive category development was applied. Results The analysis resulted in two main categories. The first category, Individual differences in how sexual health is affected by hip and knee OA, comprises of two sub categories: Pain limits sexual health; and Strategies for sexual health in the relationship. The second main category, Varying needs for communication about sexual health, is supported by the sub categories: Physiotherapists do not ask about sexual health; and Relevance of communicating about sexual health. Conclusions Painful hip and knee OA limit sexual health to varying degrees, and individuals make adjustments or develop strategies to maintain sexual life. Sexual health is not talked about during consultations with physiotherapists or other health care professionals, indicating that patients with OA may have unmet needs regarding their sexual health. Further research is needed on how to provide support and information about sexual health in OA.
Collapse
Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | | |
Collapse
|