Let’s Talk About Sex… After Total Hip Replacement

           Most patients who undergo total hip replacement are elderly, meaning, they are probably in their 60s, 70s or 80s.  But total hip replacement (THR) patients have become younger and younger, and there is one major concern that younger patients have that elderly patients are less concerned about. 

No, I’m not talking about the risk of metal implants loosening or the need for revisions after several years due to a more active lifestyle (ex. sports) among younger patients compared to the elderly ones. 

Some, especially Filipino women, may be ashamed to ask their doctor about this, but it is a valid concern.  Honestly, not a lot of patients want to discuss this. But I had one who popped me this question recently.

As a background, my patient, a Caucasian male in his 50s, underwent total hip replacement in the US a few weeks before he consulted me.  He was recovering well and mobile, although still using a cane in one hand.  But he had a problem: he was planning to get married in a few weeks’ time, to his much-younger Filipina girlfriend. He told me that he had wanted to postpone the surgery after the wedding, but he could not bear the hip pain anymore.

So now, he and his partner were worried.  They looked at each other, they clasped hands and a slight blush came to the woman’s face. Then, she finally asked:

           "Doc, is it safe to have sex after his hip replacement?”

The apprehension is valid, and is no laughing matter. It is based on the risk of dislocating or popping the hip joint out of place during the sexual activity.

  While it is generally safe to have sexual activities after the surgery, the following are the precautions to be taken to prevent dislocating the joint.  In general, the patient should follow the same restrictions whether or not he intends to have sexual activities or not.

    1.Avoid bending the hip more than 90 degrees, like putting your legs to your chest, or sitting down very low.
    2. Avoid moving the operative leg across the midline of the body (meaning don’t cross your legs)

     3. Avoid rotating the toes of the operative leg inward or outward.

 “When can we resume sexual activity?” My patient asked further.

     After the surgical wound heals and the tissues around the total joint form a new capsule, it is generally safe to engage in sexual activity. For most patients, this occurs at 4 to 6 weeks after the surgery.

 In a period of 12 weeks or roughly 3 months, the new capsule and muscles around the new hip joint regain the strength, so after this period, the risk for dislocation is low. Before 12 weeks, there is a risk of dislocation.  In fact, most hip dislocations, for any reason, occur within the first 3 months after the surgery.

        “So what is allowed in the total hip replacement sex diet?”

      In general, the following positions should be noted (Sorry I won’t share any pictures here. Just use your imagination!)

First, female patient on top is a no-no because of extreme hip flexion. So is doggy style. Patient should also use a small pillow between the knees when he or she wants to hug and kiss the partner on his or her sides. Missionary position is the safest.

Take Home Message

Sexual activity after total hip replacement, while not usually talked about or addressed, is a legitimate concern, especially for younger hip replacement patients. Although some positions are advised to be acceptable after the surgery, it may take 4-6 weeks for the ligaments around the joint to fully heal. In general, the first 6 weeks is not the time to be  “creative”.  It may take up to 3 months, before you can resume a normal, satisfying sex life - even better than before surgery as there is no longer hip pain. In short, a total hip replacement is not a death sentence sexually!

So after the consultation with my patient, I reassured him that he will be fine. Just continue his physical therapy program I ordered for him.

       And I told him “Enjoy your honeymoon. And be sure to bring your Viagra!” J