Improvements in Sexual Activity After Total Knee Arthroplasty

Background: Sexual limitations in the setting of total knee arthroplasty (TKA) are poorly understood.

Methods: Surveys were designed to assess preoperative and postoperative sexual function, and limitations were retrospectively administered to 91 sexually active TKA patients at an average of 2.1 years (range, 0.5-4.0) after surgery. Preoperative and postoperative responses were compared using 1-tailed and 2-proportion z tests, with P < .05 as the threshold for significance.

Results: Before TKA, sexual quality and/or frequency was limited in 45% of patients because of their knee. Patients experienced an average 17.1 months (range, 0-60) of sexual limitations before surgery, resulting largely from pain (87%) and diminished range of motion or flexibility (44%). Fifty-five percent of patients reported the need to change their sexual positions to accommodate their knee, with 97% of these patients indicating the need to avoid kneeling during sex. Postoperatively, fewer patients had to adjust their sexual positions to accommodate their knee (55% vs 28%, P = .0005), and avoid bearing weight on the afflicted knee during sex (97% vs 79%, P = .0213). Patients resumed sexual activity after an average of 2.4 months (range, 0-18). Despite these general improvements, 25% of individuals had less sex in the first year after surgery. After 1 year of recovery, however, 60% indicated that they more easily engaged in sexual activity than in the previous year, with 84% of these patients experiencing less pain, and 30% experiencing greater mobility or range of motion.

Conclusion: TKA does not eliminate sexual limitations, but it significantly decreases kneeling dysfunction and gives patients more liberty in selecting their sexual positions.