CLINICAL RESEARCH
Impact of Total Hip Arthroplasty on Sexual Activity and Life
Satisfaction: An Underexplored Aspect
Ezequiel Lulkin,
Sebastián Pereira, Fernando Bidolegui
Orthopedics and
Traumatology Service, Hospital Sirio Libanés, Autonomous City of Buenos Aires, Argentina
ABSTRACT
Introduction: Sexual
activity and life satisfaction are important outcomes for patients undergoing
total hip arthroplasty (THA), yet they remain underexplored in routine assessments. Materials and
Methods: Retrospective study with paired pre- and postoperative
evaluations in 40 adults (20 women, 20 men). Variables analyzed
included sexual activity (yes/no), hip pain limiting sexual activity (yes/no),
pain during sexual activity (frequency), and sexual satisfaction (5-point scale). Results:
The proportion of sexually active patients increased from 60% (24/40) to 75%
(30/40), an absolute change of +15 percentage points. Patients reporting hip
pain that limited sexual activity decreased from 12 (30%) to 6 (15%) (p =
0.031). Among the 30 patients who were sexually active postoperatively, 13.3%
reported pain during sexual activity (“often”). High sexual satisfaction
(scores 4–5) increased from 12.5% to 62.5%. Of the 10 patients (25%) who
remained inactive after surgery, 7 attributed it to
lack of desire or absence of a partner, and 3 to concern or fear. Conclusions:
Total hip arthroplasty was associated with increased sexual activity, reduced
limiting pain, and a marked improvement in reported sexual satisfaction.
Prospective studies are needed to confirm these
findings.
Keywords: Total hip
arthroplasty; sexual activity; sexual satisfaction; pain; quality of life.
Level of Evidence: III
Impacto del reemplazo total de cadera
en la actividad sexual y satisfacción de vida: un aspecto poco explorado
RESUMEN
Introducción: La actividad sexual y la satisfacción
de vida son dimensiones relevantes para los pacientes sometidos a un reemplazo total de cadera; su evaluación específica
sigue poco explorada. Materiales y Métodos: Estudio retrospectivo con mediciones
pre y posoperatorias en 40 pacientes adultos (20 mujeres, 20 hombres). Se
analizaron las siguientes variables: actividad sexual (sí/no), dolor de cadera
limitante para la actividad sexual (sí/no), dolor durante la actividad sexual
(frecuencia) y satisfacción sexual (escala 1-5). Resultados: La proporción de
pacientes activos sexualmente aumentó del 60% al 75%, un cambio absoluto +15
puntos porcentuales. La cantidad de pacientes con dolor de cadera limitante
para la actividad sexual disminuyó de 12 (30%) a 6 (15%) (p = 0,031). El 13,3%
de los 30 pacientes activos después de la cirugía refirió dolor durante la
actividad sexual (“a menudo”). La satisfacción sexual “alta” (niveles 4 y 5)
aumentó del 12,5% al 62,5% de los pacientes. De los 10 (25%) que permanecieron
inactivos después de la cirugía, 7 lo atribuyeron a la falta de deseo o a la
ausencia de pareja y 3, a preocupación/miedo. Conclusiones: El reemplazo total
de cadera se asoció con una mayor actividad sexual y menos dolor limitante, y
un incremento marcado de la satisfacción sexual reportada. Se requieren
estudios prospectivos para confirmar estos hallazgos.
Palabras clave: Reemplazo total de cadera; actividad
sexual; satisfacción sexual; dolor; calidad de vida.
Nivel de Evidencia: III
INTRODUCTION
Total hip arthroplasty
(THA) is a fundamental procedure in the treatment of degenerative joint
diseases that significantly affect patients’ quality of life. The main
objectives of this surgery are to improve joint function and reduce pain, but
other aspects of patients’ daily lives also deserve attention, including sexual
activity.1,2
Sexual activity is a vital
component of physical and emotional health, and its alteration can have
significant consequences on overall well-being. In the scientific literature,
the relationship between THA and sexual activity has been only marginally
addressed, leaving a gap in understanding the postoperative impact on patients’
lives.3,4
This retrospective study
focused on evaluating how THA influences sexual activity and overall life
satisfaction. Through the implementation of pre- and postoperative
questionnaires, we sought to identify changes in the frequency of sexual
activity, pain during sexual activity, and levels of sexual and overall
satisfaction, thereby obtaining a broader perspective of surgical outcomes
beyond improvements in joint function. The study aims to shed light on a
little-explored topic.
MATERIALS AND
METHODS
A retrospective study was conducted to evaluate the influence of THA on patients’
sexual activity and overall life satisfaction. The research was
based on standardized questionnaires that included a preoperative
section answered by patient recall and a postoperative section (Appendix).
The study
was approved by the Ethics Committee of Hospital Sirio
Libanés before the surveys were administered.
Forty patients (20 men and
20 women), aged 60–75 years (mean age 70), were included. Inclusion criteria
were a diagnosis of hip osteoarthritis and clinical indication for THA.
Patients with previous hip surgery or medical conditions preventing
participation in sexual activity were excluded. The sample was formed by stratified random sampling by sex (20 men
and 20 women).
Two questionnaires were designed to collect data on sexual activity and overall
satisfaction. The instruments were developed from the
literature and clinical practice but lack formal psychometric validation. The
sexual satisfaction scale was administered to all
participants, regardless of their sexual activity, to assess satisfaction,
desire, and expectations.
The preoperative
questionnaire assessed sexual activity before surgery, frequency of pain during
sexual activity, and level of sexual satisfaction. The postoperative
questionnaire collected information on resumption of sexual activity, pain
during sexual activity, and ratings of sexual and overall satisfaction after
surgery.
Statistical
Analysis
A descriptive analysis of
quantitative and qualitative variables was performed.
Continuous variables are expressed as mean and standard
deviation, and categorical variables as frequency and percentage. Appropriate
statistical tests were used to compare pre- and
postoperative responses (paired design). Likert scales were
treated as quasi-interval variables, applying the paired Student’s
t-test as an approximation and, where appropriate, the Wilcoxon test.
Dichotomous variables (sexual activity and limiting pain) were
analyzed using the exact two-tailed McNemar test. Two-tailed p-values and 95% confidence
intervals are reported. A p-value <0.05 was
considered statistically significant.
No comparisons between men
and women were performed; this analysis will be
considered in future studies.
For sexual satisfaction
(ordinal scale), a descriptive preoperative–postoperative transition matrix is
presented.
RESULTS
The distribution by sex was
equal (20 men and 20 women). Before surgery, 24 patients (60%) reported being
sexually active. Of the 16 who were not active, 12 attributed their inactivity
to hip pain or discomfort, and 4 to other reasons
(e.g., lack of desire or absence of a partner). All 40 participants responded
regarding preoperative sexual satisfaction: 10 (25%) reported low satisfaction
(levels 1–2); 25 (62.5%) reported moderate satisfaction (level 3); and 5 (12.5%) reported high satisfaction (levels 4-5).
After surgery, 30 of the 40
patients (75%) reported being sexually active. Among the 10 (25%) who did not
resume activity, the main reasons were lack of desire or not having a partner
(70% of inactive patients; 17.5% of the total) and concerns or fear (30% of
inactive patients; 7.5% of the total). Four of the 30 active patients (13.3%)
reported pain during sexual activity after surgery, all describing it as
occurring “often.” In this group, 27 (90%) rated their sex life as “improved,”
and 3 (10%) as “unchanged.” Twenty-five of the 40
(62.5%) rated postoperative sexual satisfaction as “high” (levels 4–5) (Figures 1 and 2, Tables 1-3).
DISCUSSION
The results of this
retrospective study demonstrate improvements in sexual activity and overall
life satisfaction after THA. Other studies have also examined the implications
of THA on patients’ sexual activity. In particular, Turhan
and Buyuk3 found that sexual
quality of life improved significantly after bilateral THA, supporting our
findings of improved postoperative sexual satisfaction. Yoon et al.,4 in a study
of Korean patients, also reported improvements in sexual activity and
satisfaction after this surgery. However, they highlighted the insufficient
patient education regarding the resumption of sexual activity, an aspect not
specifically addressed in our study, but potentially relevant for future
research and clinical practice.
Galloway et al.5 studied sexual function and return to
sexual activity in young adults after THA and reported significant improvement
in sexual function, consistent with our findings of increased satisfaction and
decreased pain. Similarly, Yang et al.,6 in a study of young Chinese
patients, reported improved sexual satisfaction scores in both men and women
after THA, reinforcing our findings of postoperative improvement.
A systematic review by Neonakis et al.7 confirmed that THA improves sexual
satisfaction and reduces physical barriers limiting sexual activity. This
strongly supports our observation that sexual activity is a major concern for
patients and that THA is associated with improved outcomes. Bonilla et al.8
investigated the impact of THA on women’s sexual satisfaction and found
significant postoperative improvements. However, they identified the need for more
effective communication and counseling, an aspect also suggested by our finding that a small proportion
of patients did not resume sexual activity due to concerns or fear.
Similarly, Wall et al.9
emphasized the importance of addressing sexual activity both before and after
THA. Their study found that 77% of patients believed their hip disease limited
their sex life and considered resumption of sexual activity important. However,
many felt they did not receive enough information about postoperative sexual
activity, consistent with our observation of the need for better communication
between patients and surgeons. Wall et al.9 also highlighted that most surgeons fail
to adequately discuss sexual activity with patients due to the sensitivity of
the subject and the lack of standardized measures to evaluate sexual function
after THA.
Our study confirmed the
positive effect of THA on sexual activity and overall life satisfaction.
Unlike previous studies, we
found that a small percentage of patients did not resume sexual activity after
surgery due to concerns or fear, underscoring the need for healthcare
professionals to provide more effective communication
and counseling. Future research should address this
gap in patient education to improve overall recovery and quality of life after
surgery. In addition, the inclusion of validated outcome measures that
incorporate sexual activity should be considered, to
facilitate discussion of this sensitive issue between patient and surgeon.
Despite the limitations
inherent in its retrospective design and sample size, the results obtained are
statistically significant and provide a solid foundation for future research.
Prospective studies with larger and more diverse samples are
recommended to confirm these findings and to further explore the impact
of THA on intimate relationships and body image.
CONCLUSIONS
This study provides
evidence that THA not only improves mobility and relieves pain, but also has a
positive effect on sexual activity and overall life satisfaction, which are
fundamental aspects of comprehensive patient recovery.
Statement on generative AI and
AI-assisted technologies in the writing process
During
the preparation of this manuscript, the authors used AI to improve readability,
language, and review statistical consistency. After using this tool, the
authors reviewed and edited the content as necessary and assume full
responsibility for the content of the publication.
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APPENDIX
Preoperative Questionnaire:
Were you sexually active before surgery?
[ ] Yes
[ ] No
If you were not sexually active, was it due to hip
pain or discomfort?
[ ] Yes
[ ] No
If you experienced hip pain during sexual activity,
how often did it occur?
[ ] Always
[ ] Often
[ ] Sometimes
[ ] Rarely
Did pain affect your desire for sexual activity?
[ ] Yes
[ ] No
On a scale from 1 to 5, how
would you rate your sexual satisfaction before surgery? (1 = not satisfied at
all, 5 = very satisfied)
[ ] 1
[ ] 2
[ ] 3
[ ] 4
[ ] 5
Postoperative
Questionnaire:
After surgery, did you resume sexual activity?
[ ] Yes
[ ] No
If you have not resumed sexual activity, what is the
main reason?
[ ] Pain or
discomfort
[ ] Concern
about damaging the prosthesis
[ ] Lack of
desire
[ ] Medical
advice
[ ]
Relationship issues
[ ] Other
reasons (please specify):_______________
After surgery, have you experienced hip pain during
sexual activity?
[ ] Yes
[ ] No
If you answered yes to pain, how often does it occur?
[ ] Always
[ ] Often
[ ] Sometimes
[ ] Rarely
Compared with before surgery, how would you rate your
sex life?
[ ] Better
[ ] The same
[ ] Worse
On a scale from 1 to 5, how
would you rate your sexual satisfaction after surgery?
[ ] 1
[ ] 2
[ ] 3
[ ] 4
[ ] 5
On a scale from 1 to 5, how
would you rate your overall satisfaction with your quality of life after
surgery?
[ ] 1
[ ] 2
[ ] 3
[ ] 4
[ ] 5
S. Pereira ORCID ID:
https://orcid.org/0000-0001-9475-3158
F. Bidolegui ORCID ID: https://orcid.org/0000-0002-0502-2300
Received on June 24th, 2025. Accepted after evaluation
on August 30th, 2025 • Dr. Ezequiel Lulkin • ezelul@gmail.com • https://orcid.org/0000-0002-4119-0483
How to cite this article: Lulkin E, Pereira S, Bidolegui
F. Impact of Total Hip Arthroplasty on Sexual Activity and Life Satisfaction:
An Underexplored Aspect. Rev Asoc Argent Ortop Traumatol 2025;901:464-471. https://doi.org/10.15417/issn.1852-7434.2025.90.5.2187
Article Info
Identification: https://doi.org/10.15417/issn.1852-7434.2025.90.5.2187
Published: October, 2025
Conflict of interests: The authors declare no conflicts of interest.
Copyright: © 2025, Revista de la
Asociación Argentina de Ortopedia y Traumatología.
License: This article is under Attribution-NonCommertial-ShareAlike 4.0
International Creative Commons License (CC-BY-NC-SA 4.0).