Hip replacement may improve sex life

SINGAPORE — It is well known that total hip replacement improves mobility and reduces pain. Now, new research shows the surgical procedure offers an unexpected bonus in the bedroom too.

Hip problems, which affect not only the old, can cause pain, limit movement and affect everyday activities such as walking or bending.

Younger adults with hip problems are usually born with them or have a condition called avascular necrosis, which occurs when bone tissue dies due to a lack of blood supply. Among the elderly, osteoarthritis and hip fractures are the main culprits of hip pain.

Hip and knee specialist Dr Chin Pak Lin, medical director of The Orthopaedic Centre, said people with hip problems often cannot rotate their hips or part their thighs.

“If a person has difficulty getting in and out of a car, imagine the pain during sex,” said Dr Chin.

“Restricted hip movements mean they have problems with squatting, bending, etc. Not only does it cause hygiene problems in the groin region, it can certainly affect their ability to have sex,” he said.

Having a healthy sexual relationship is an essential part of emotional and physical well-being. However, many patients are reluctant to discuss this with their surgeons, said Dr Lim Chin Tat, associate consultant from National University Hospital’s Division of Hip and Knee Surgery.

Sexual difficulties have been reported in two-thirds of patients under the age of 60 who underwent hip replacement surgery, said Dr Lim. The main culprits for their sexual dysfunction were hip stiffness and pain. Hip replacement surgery can address these limitations, said the experts.

NEW SURGICAL TECHNIQUES

First introduced in the ’60s, total hip replacement techniques have evolved over the years.

Dr Lim said: “During surgery, entering the hip joint from the back (posterior approach) is the more popular route. However, due to the concern with dislocation, there is a trend towards performing hip replacement through the side (lateral approach) now.”

However, Dr Chin said there is no clear-cut winner as each technique has its pros and cons. As with any surgery, hip replacement procedures have their risks too, including hip dislocation, nerve and vessel damage, and infection.

“Hip replacement surgery is generally less forgiving than a knee replacement surgery. The surgeon has to navigate a tight space with lots of vital structures nearby,” said Dr Chin.

That is why surgery is typically considered as the last option after exhausting non-surgical treatment, said Dr Lim. Non-surgical treatment options include resting the joint, physiotherapy and the use of non-steroidal anti-inflammatory medication.

“Surgery is considered when the arthritis limits everyday activities such as walking and bending, when the pain continues even at rest, or when the stiffness in the hip causes problems moving or lifting the leg,” said Dr Lim.

He added that younger patients are generally not ideal candidates for the surgery. When performed early, the procedure may not last the patient’s entire lifespan. “They may need to undergo revision surgery, which tends to be more major. Moreover, younger patients have higher activity demand and thus tend to wear out the joints more rapidly,” he said.

About five in 100 patients Dr Chin sees for hip conditions are under the age of 50.

RESUMING LIFE AFTER SURGERY

One of Dr Chin’s patients is a 26-year-old IT business analyst. Born with a hip deformity, he put up with chronic hip pain, which gradually worsened over the years.

The intense pain made him unable to walk properly despite taking strong painkillers. It also took a toll on the married man’s sex life.

He said: “Foreplay required a lot of careful thinking about the positioning or the angle of the hip. Now I can have a wide range of hip movements, including being able to touch my chest with my left knee.”

He added: “The quality of my sexual relationship with my wife has improved after my surgery. I now walk at least 10,000 steps a day and have since hiked two mountains.”

In general, most patients are able to resume sexual activity six weeks after hip replacement surgery, said Dr Chin. However, this varies with each patient.

“The main concern with resuming sexual activity is the risk of hip dislocation. It is important to avoid more than 90° of bending, rotating the hip inwards and crossing the legs as there is a higher chance of hip dislocation in these positions,” said Dr Lim.

With the availability of newer-generation hip implants that last longer, Dr Chin said younger patients no longer need to suffer in pain until they are “old enough” to need a hip replacement.

“Plus, better-revision implants are now available to patients who need to change their implants later in life,” said Dr Chin.