What are safe sexual positions for a patient after total hip replacement surgery?

Safe Sexual Positions After Total Hip Replacement

Patients should resume sexual activity in the supine position (lying on their back, partner on top) as this is the safest position to prevent hip dislocation after total hip arthroplasty, and can typically return to sexual activity 1-3 months postoperatively once they can comfortably perform moderate physical activities like climbing stairs. 1, 2, 3

Timing of Return to Sexual Activity

• Most patients can safely resume sexual activity 1-3 months after uncomplicated total hip replacement, with the median time being 3 months postoperatively 1, 4
• Before resuming intercourse, patients should be able to perform moderate physical activities (3-5 METs) such as climbing one flight of stairs or walking briskly without significant pain or difficulty 5, 6
• Light intimate activities like hugging, kissing, and cuddling can begin earlier once immediate post-operative discomfort resolves, serving as a bridge to assess tolerance 5
• The majority of patients (55%) are able to resume intercourse within 1-2 months after surgery 2

Recommended Sexual Positions (Ranked by Safety)

Safest Position

• Supine position (patient on bottom, partner on top) is the most preferred and safest position after total hip arthroplasty, as it minimizes risk of hip dislocation by avoiding extreme flexion, adduction, and internal rotation 2, 3

Alternative Safe Positions

• Side-lying on the non-operative hip is the second most comfortable position for female patients 2
• Prone position (patient on top) is the next most comfortable for male patients, though it requires more energy expenditure 2
• Semi-reclining or bottom positions decrease physical effort required and are generally safe 5

Positions to Avoid

• Any position requiring excessive hip flexion beyond 90 degrees should be avoided 3
• Positions causing hip adduction (crossing the operative leg past midline) increase dislocation risk 3
• Positions requiring internal rotation of the operative hip should be avoided 3

Key Precautions and Hip Movement Restrictions

• The primary concern is preventing posterior hip dislocation, which occurs with combined hip flexion beyond 90 degrees, adduction, and internal rotation 3, 4
• Patients should avoid excessive flexion and internal rotation of the operative hip during sexual activity 7
• 39% of patients experience difficulties with leg positioning following total hip replacement and need to modify coital positions 4

Patient Assessment Before Resuming Activity

• Ensure patients can climb stairs or walk briskly without excessive pain or fatigue 5
• Verify that urinary and bowel function have normalized 5
• Confirm the patient is well-rested before attempting sexual activity 5, 6

Warning Signs to Stop and Seek Medical Attention

• Persistent or severe hip pain during or after sexual activity 5
• Excessive fatigue or shortness of breath that doesn't resolve with rest 5
• Any sensation of hip instability or "giving way" 3
• Patients should stop immediately if discomfort occurs and resume only when comfortable 5

Common Patient Concerns and Counseling Points

• Dislocation is the most common fear among patients regarding sexual activity after total hip replacement 4
• 76% of patients identify hip arthritis as the primary cause of pre-operative sexual problems, with pain and stiffness being most common 1
• Post-operatively, 44% of patients report improvements in sexual satisfaction and 27% report increased intercourse frequency 1
• 89% of patients desire more information regarding sexual function after surgery, preferably in written form 2

Critical Gap in Care

• 86% of surgeons rarely or never discuss sexual activity with their patients, despite it being an important quality of life issue 1
• Most patients are unable to obtain information on sexual activity and do not consult physicians due to the private nature of the topic 4
• Healthcare providers should proactively initiate these discussions and provide written educational materials 2, 8

Gender Differences

• Male patients are statistically more likely to resume intercourse sooner than female patients after total hip replacement 2
• Female patients prefer side-lying positions more than males 2
• Male patients more commonly prefer prone positions as their second choice after supine 2

Energy Expenditure Considerations

• Sexual activity requires approximately 3-5 METs of energy expenditure, similar to climbing one flight of stairs 5, 6
• Masturbation and non-coital activities require less than 3 METs and represent the lowest energy expenditure options 6
• The person on top during missionary position expends the most energy, while the person on bottom expends less 7