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When can I resume intimacy after joint replacement?
Whenever it is comfortable. There is no set number of weeks, and there is nothing special about a particular date on the calendar. Let pain be your guide.
In the first weeks, most people find it easier when the partner who had surgery can stay in a more passive position and let the other partner do more of the moving. Go slowly, and stop if something hurts.
This is a normal question, and it comes up far more often than people ask it out loud. If you would rather not raise it in an exam room, call the office. It gets asked every week.
“It really is whenever it is comfortable. Let pain be your guide, and you don’t want to be locked into one position. Early on, certain positions will be more comfortable, with the person who had surgery in a more passive role.”
Does the type of hip replacement change the advice?
Yes. After a hip replacement, the main concern is dislocation, and which positions matter depends on how your surgery was done. If you do not know which approach you had, ask your surgeon before you resume.
After an anterior hip replacement (the approach I use for most of my patients), there are far fewer limits. Avoid the extremes of motion, and in particular avoid extreme extension of the hip, where the leg is stretched far back behind you. Most comfortable positions are fine. The single precaution after anterior surgery is covered in anterior hip precautions.
After a posterior hip replacement, follow your surgeon’s precautions closely, especially in the early weeks. The usual rule is not to bend the hip past 90 degrees. That means avoiding positions where the knees are drawn up toward the chest or the hip is deeply bent, and avoiding turning the knee of the operated leg inward.
Which positions are usually most comfortable?
Described plainly, and as a starting point rather than a rule:
- Lying on your back, with the partner who had surgery underneath. It lets you stay passive and keep the operated leg supported. A pillow under the knee can help, especially after a knee replacement.
- Standing, gently bent forward at the waist, supported by a bed or counter at a comfortable height. The partner who had surgery keeps weight on both feet. After a posterior hip replacement, keep the forward bend gentle so the hip stays within the 90-degree rule.
- Lying on your side, operated side up, with a pillow between the knees for support, can also be comfortable after a knee replacement.
Early on, avoid positions that put weight on a healing knee or force a hip to its limits. And whatever position you choose, if it hurts, stop and change.
What does the research say?
The research on this subject is small and mostly older, but it points in a consistent direction.
Surgeons rarely bring it up. A review of 10 studies found that 86 percent of surgeons rarely or never discuss sexual activity with their hip replacement patients, even though it matters to patients.[1] In that review, 76 percent of patients said hip arthritis was the main cause of their sexual problems, and after hip replacement 44 percent reported improved sexual satisfaction.[1]
A 2014 motion-capture study looked at which positions could put a hip replacement at risk.[3] Researchers recorded 12 common positions using two volunteers and applied the movements to computer models of hip implants. Positions that required bending the hip deeply, more than about 95 degrees, created a risk associated with posterior dislocation. One position that combined turning the leg outward with extension of the hip created a risk associated with anterior dislocation. Two cautions: the study is from 2014, used only two volunteers and computer models, and may be more restrictive than what your own surgeon recommends today, especially after anterior hip replacement. Two of its authors worked for an implant manufacturer.
After knee replacement, a survey of 91 patients found that 45 percent had their sex life limited by their knee before surgery, mostly because of pain and stiffness, and most had to avoid kneeling.[2] After surgery, fewer needed to change positions for their knee (28 percent, down from 55 percent). One in four had less sex in the first year while they recovered, but after a year, 60 percent said intimacy was easier than the year before.[2]
The older studies report people returning to sexual activity at an average of about two and a half months after knee replacement[2] and about four months after hip replacement,[1] but those averages come from an era of more restrictive advice. In my practice, comfort sets the timeline.
What about my new knee?
After a knee replacement there is more swelling and stiffness than after a hip, but less risk. The implant is not the limit; comfort is.
- Kneeling on the new knee is allowed once the incision is completely healed, usually around four weeks. It can feel uncomfortable at first, and it will not damage the implant. More on this in kneeling after knee replacement.
- Swelling and stiffness make some positions uncomfortable in the first weeks. Pillows under or beside the knee help. See also swelling.
- Improvement continues through the first year as motion and strength come back.
How do we talk about it?
Out loud. The part that matters more than any position is an open conversation with your partner. This should never become a pressure situation, and nobody should end up in an uncomfortable or compromised position because it felt easier not to talk about it.
“An open discussion is important. This shouldn’t be a pressure situation. We don’t want to put you in a compromised position.”
When should I call my surgeon?
After a hip replacement, sudden severe hip or groin pain, being unable to put weight on the leg, or a leg that suddenly looks shorter or turned in or out can mean a dislocation. That is an emergency: go to the emergency room. More in dislocated hip replacement.
For anything else that worries you, call. If you’re worried, I’m worried. Our clinic number is answered 24 hours a day.
Joint replacement care in Franklin, Nashville, and Middle Tennessee
I perform hip and knee replacements at the Bone and Joint Institute of Tennessee in Franklin, on the Williamson Health campus, for patients from Franklin, Brentwood, Nashville, Spring Hill, Nolensville, Murfreesboro, and across Middle Tennessee. No question about your recovery is off limits.
Download the printable guide (PDF)
This article is for educational purposes only and does not replace personalized medical advice. Recovery instructions vary by individual health factors and surgical approach; always follow the guidance of your own surgical team. In an emergency, call 911.
References
- Issa K, Pierce TP, Brothers A, Festa A, Scillia AJ, Mont MA. Sexual activity after total hip arthroplasty: a systematic review of the outcomes. J Arthroplasty. 2017;32(1):336-340. doi:10.1016/j.arth.2016.07.052
- Kazarian GS, Lonner JH, Hozack WJ, Woodward L, Chen AF. Improvements in sexual activity after total knee arthroplasty. J Arthroplasty. 2017;32(4):1159-1163. doi:10.1016/j.arth.2016.11.001
- Charbonnier C, Chagué S, Ponzoni M, Bernardoni M, Hoffmeyer P, Christofilopoulos P. Sexual activity after total hip arthroplasty: a motion capture study. J Arthroplasty. 2014;29(3):640-647. doi:10.1016/j.arth.2013.07.043
