Each year, well over a million total joint replacement surgeries are performed in the U.S. — including over 700,000 knee and 300,000-plus hip replacements. Artificial joints made of metal and high-grade plastics are implanted to replace natural joints that have been damaged — most often as a result of severe arthritis.
Though the major surgery is not without risks, like infection — and joints can fail, requiring additional surgery — the hip and knee replacement operations tend to be highly effective. The vast majority of patients see significant improvement in restored function that enhances mobility and relief from pain. That can lead to a person being more active often — whether in recreational sports or playing with kids or grandkids. And though research on the impact of joint replacement on function tends to be more general, experts say it certainly seems that, for those who have a procedure done, it can provide a boost in the bedroom as well.
“We know that just like most movement is painful before surgery, and in the overwhelming majority of cases that movement is made markedly less [painful or] not painful after surgery, it affects both their non-sex and their sex life meaningfully,” says Dr. Jose A. Rodriguez, a hip and knee surgeon at the Hospital for Special Surgery in New York City. Adds Dr. Claudette Lajam, an orthopedic surgeon at NYU Langone Health, also in NYC: “Especially [with] large joints like the hip and the knee, when you have bad arthritis, it not only impacts mobility, but it impacts your comfort — and it’s pretty difficult to enjoy an intimate relationship and intimacy when you’re in pain or when you can’t move.” Joint replacement can both address mobility issues and relieve pain. “And that can, for the long term, really improve people’s ability to have intimacy with their partners,” Lajam says.
[See: How to Prepare for Hip Replacement Surgery.]
Returning to Action
However, as with other major surgeries, getting back into action after joint replacement takes time — and perhaps a bit of forethought (and not just foreplay). Surgeon recommendations vary somewhat regarding when it’s generally safe to resume sexual activity following surgery from a couple weeks, or less than a month, to six to 12 weeks. Experts agree, though, that it varies for each patient. What’s more, you should pay attention to how the joint feels when you resume sex — and, of course, pay attention to whether you’re comfortable in a given position. “If it’s painful, [it’s] probably not a good idea,” says Dr. Charles Nelson, chief of the Joint Replacement Service at Penn Medicine in Philadelphia. “And even if it’s painful afterwards, then you probably should wait a little while before you do it again.” And at least initially post-op, particularly after hip replacement, sexual position may need to be considered as well.
The majority of hip replacement surgeries are currently done taking a posterior approach — with the incision done in the back of the hip; and this can affect precautions a person might take, including with sex, after the operation. “With hip surgery performed through a posterior approach … you shouldn’t bring your hip up towards your chest, or rotate the knee inwards toward the middle of the body beyond 90 degrees. The reason is that when a posterior approach is performed, the ligaments that hold the hip in place are cut and repaired; and so until that tissue heals, that risk is there,” Rodriguez says. The main concern is that overexertion or overextension could possibly dislocate the joint after surgery, though the risk of that is low. For these patients, Rodriguez says, there’s a 1 percent risk of dislocation; and 20 to 30 percent of the time that will become recurrent and require surgery to fix the issue. Despite the highly effective nature of joint replacement surgery, Nelson notes, “a hip replacement is never as stable as a native, or natural, hip.”
Still, surgeons point out that any restrictions related to sex after joint replacement surgery are typically temporary. But recovery is a process, from surgical wound site healing in the initial weeks, to longer-term tissue healing that can take upwards of a year and bone naturally knitting to the artificial joint, as well as physical rehab post-surgery. So it’s important, experts say, to take it in stride and keep your surgeon apprised of any concerns.
[See: 8 Lesser-Known Ways to Ruin Your Joints.]
Taking a Position
Perhaps more than any other activity, sex is wildly variable — and position can make all the difference between what’s enjoyable and what’s excruciating post-joint replacement. “With the knees apart it’s safer to bring your legs up — and so missionary position for females is still relatively safe,” Rodriguez says. Whereas, it may be best to avoid, say, “doggy style” — at least in the early-going after surgery. “Because there the knees are often close together and the knee can be flexed greater than 90 degrees — that’s a little bit of more of a risky position,” Rodriguez says.
There are even a smattering of online references, including from the health care technology startup PeerWell and Mount Nittany Health, going through sexual positions that may or may not be as safe following surgery. Along with missionary position, sex seated in a chair, with a woman sitting in a man’s lap, is also suggested as a safe option; whereas for a woman who has recently undergone posterior hip replacement, something like face-to-face side sex, where she wraps her leg around her partner, may put her at risk for hip dislocation.
However, with knee replacement and anterior approach hip replacement — where the surgery incision is made through the front of the hip — there’s typically not the same positional restrictions. “For a knee, or for an anterior approach hip [replacement], most surgeons will say when you feel comfortable, you can return to sexual activity,” Rodriguez says.
But for men and women, straight or gay couples — depending on everything from the procedure to sexual preferences — what works best in the bedroom (or the kitchen or wherever) after surgery is different for each person. That’s precisely why clinicians emphasize patients should talk with their surgeons to address any questions and concerns they have about sex, specific to their circumstances.
Unfortunately, frequently neither doctors nor patients broach the subject. Based on anonymous patient safety survey data, Rodriguez has found that most patients and doctors don’t discuss sex after joint replacement surgery, despite the fact that for many it’s a key consideration when they decide to undergo hip or knee surgery.
Slowing It Down
Along with talking to your surgeon and being cognizant of things like sexual position and of course pain, you might also consider taking it slow — for recovery reasons.
[See: These Medicines May Cause Bone Loss.]
Easing back into sex is typically safer than going hard at it — right off the bat. And where some people are overly cautious — avoiding movement that’s helpful with recovery — clinicians say others, feeling great, get overconfident and try to do too much too soon. “Just as if someone were asking me, ‘Can I run a marathon?’ or ‘Can I go play tennis?’ if you … do something that’s very vigorous during intimacy, you should ask your doctor about it,” Lajam says.
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Post-Joint Replacement Sex: a Guide to Getting It On Safely After Surgery originally appeared on usnews.com
