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

Total Hip Replacement: What You Need to Know

      In one of my previous posts (5-favorite-exercises-for-patients-with arthritis), I discussed exercise tips for osteoarthritis patients to delay the progression of the disease.  However, in cases where the pain has become unbearable and activities of daily living have been affected, total joint replacement is now the treatment of choice. 

To reiterate, total hip replacement surgery is for patients with severe arthritis of the hips and is the last resort when all non-surgical treatments have failed to alleviate the pain.

 

Total hip replacement patient after the surgery

Some of the contents of this post are not original ideas. You can read them in the internet written by a famous guy (Dr. Anonymous).  You can see his works everywhere. 

However, I rearranged the facts and added my own thoughts. 

In other words, I perfected it.

Says who? Two brilliant people: My father and my mother.

Okay, back to my topic. 

“Doc, what is total hip replacement?”

Total hip replacement is when the worn out hip joint is replaced by an artificial hip, thus creating a brand new hip joint. 

As a background, our hip joint is that part of the body where the thigh bone meets the hip bone. The head of the thigh bone is shaped like a ball and this fits into a socket on the hip bone. Thus, the term “ball-and-socket” joint.  During our youth, this ball and socket joint has a smooth surface and is well-lubricated.  As we age, surfaces begin to wear out, lubrication lessens, causing the ball and socket to rub against each other. This causes stiffness and pain, eventually curtailing the person’s activities. 

“Doc, what happens during the surgery?”

As mentioned, the damaged parts of the hip are removed and artificial implants are put in their place. 

A metal cup is fixed to the hip bone and a metal stem is attached into the thigh bone. Imagine the “bulalo¹” where the hollow part in the middle is where the implant’s “stem” is placed.  A ball is placed on top of this stem and an anti-friction material is used to line all the exposed parts. Metal, plastic and ceramics are some of the materials used. The hip is then reassembled to create a brand new hip joint. Rest assured that this is done with you under anesthesia and you will not feel anything during the whole duration of the surgery!

“Doc, where is my incision going to be located?”

The incision is not transverse along your waist or we may cut you into two parts.  Just kidding. Most incisions are placed on the side of the hip, vertically. In traditional hip replacement, a 15-18 centimeter incision is made on the hip. Some surgeons use smaller incisions, called minimally invasive surgery. The outcome, however, has not been proven to be better, beyond the immediate period after surgery.  As the saying goes, it is not the size that matters, it’s the performance!

 “Doc, what are the things needed before the surgery?”

Preparation for hip replacement surgery starts a few weeks before the surgery. Use this time to clarify doubts, arrange finances and ready your home for rehabilitation. You are advised to avoid aspirin as this may cause bleeding. Blood tests and x-rays are also undertaken and you will be put on antibiotics just before surgery to counter possible infections.

“How much does a total hip replacement cost?”

This is probably the most difficult and most important to answer, but sensitive to discuss outside of you and your doctor.  There are a lot of factors that influence it.  These include the hospital, the brand of implant to be used, the length of stay in the hospital, and of course, the PF of the surgeon, anesthesiologist, and internist if needed.  If you have Philhealth benefits, you can use that to lower the cost of hospitalization. (Make sure you are up to date in your monthly contribution).  

In the Philippines,  there is no standard PF.  Some surgeons charger higher PFs than others. For some patients, the amount is peanuts, but for some, the amount is their whole net worth, which will be zapped into oblivion if they decide to undergo surgery! 

“Doc, how risky is the procedure?”

98% of total hip replacement patients become successful.   The 2% represent the ones who develop complications, such as infection, dislocation, nerve injury or blood clot formation.  I always tell my patients that there is no 100% surgery.  Just like when you ride an airplane, do you think that every time you ride it, you will reach your destination? Only God knows!  

“Doc, how long will be my recovery period?”

Patients must be prepared that recovery will not always be immediate and dramatic. Instead, time, coupled with medication and physical therapy will heal you and a normal active life can be regained gradually. In general, however, you need to stay at least 4 days in the hospital.   You will be asked to sit up the day after surgery and walk with a walker as you can tolerate. PT then can be done as outpatient.  The time taken to recover completely from the surgery differs from person to person. However, a positive attitude can do wonders and hasten the recovery process considerably!

“Doc, is my total hip implant going to last forever?”  

The procedure and technology is continually being refined and updated so as to meet the needs of the patients more effectively.  However, as of this time, we cannot assure 100% that there will be no future surgeries.  The younger you are, the more likely future revision surgeries might happen because younger patients tend to be more active, and hence, apply more stress on the hip implants. But a well performed total hip replacement will last around 15-25 years.   If you’re on your 70’s with minimal activities, most likely, you will outlive your total hip implant.

If you are suffering from severe hip pain enough to curtail daily activities, think about total hip replacement. Who doesn't want to have more mobility and to be able to do the things he used to do? Hip replacement tends to be very successful because they can greatly enhance the quality of your life. Check if total hip replacement is for you.

^{1  Filipino viand consisting of the thigh bone of a cow and its bone marrow}