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 A year after surgery, about 40% of patients said their expectations
of sexual activity weren't met, researchers report in Clinical
Orthopaedics and Related Research.
"Patients generally have high expectations towards the results of a
prosthesis and expect to remain active despite their age, which also
includes sexual activity," said study leader Rita Harmsen of Leiden
University Medical Center in the Netherlands.
"Sexual activity is important to quality of life for men and women
alike, however, sexual issues are not easily discussed -- not in
daily life, not in the consultation room, not by specialists, not by
patients," she told Reuters Health by email. "After surgery,
effective instructions (about how to safely resume) are missing, and
surgeons are not aware of hidden questions."
Harmsen and colleagues analyzed data for more than 800 patients
scheduled for total knee replacement in 2012-2015 at seven hospitals
in The Netherlands. Patients ranked their preoperative expectations
and postoperative fulfillment on a 5-point scale.
Before the knee replacement surgery, about half of patients expected
better sexual activity after recovery. Men were more likely to have
expectations for postoperative sexual activity, particularly men
under age 60. About 46% of men expected "back to normal" sexual
activity, compared with 32% of women. For both genders, anticipation
decreased with age.
Overall, about 58% reported fulfillment of their expectations after
surgery, which was nearly equal for men and women. Fulfilment was
slightly lower in higher age groups for both genders. Women under
age 65 experienced fulfillment more often than men of the same age.
Importantly, those in better health before surgery were more likely
to report better sexual activity after surgery. And patients who
experienced greater health improvements after surgery reported
fulfilled or exceeded sexual expectations as well.
"At the same time, about 40%, or two out of five patients,
experienced unfilled expectations," Harmsen said. "These results can
be very disappointing."
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A limitation of the study is that preoperative expectations and
postoperative fulfillment were each measured with just one survey
question, the study authors wrote. Future studies should interview
patients and their partners to understand what the expectations were
and why they're unfulfilled after surgery, Harmsen said.
Difficulties may be related to age, insufficient rehabilitation, or
the mobility of the knee after surgery, which can limit certain
sexual positions. Patients may need education about comfortable and
safe sexual positions after knee replacement, she added.
"As surgeons, we do not address this aspect often enough, and it's
important to set realistic expectations after surgery," said Dr.
Antonia Chen of Brigham and Women's Hospital in Boston,
Massachusetts. Chen, who wasn't involved with this study, is the
director of research for arthroplasty services.
In addition, longer studies may show whether it takes more than a
year after surgery for patients to return to normal sexual activity
levels or meet their expectations, she said.
"Patients who undergo total knee replacements have overall improved
physical function after surgery," she told Reuters Health by email.
"However, it is worthwhile to have a discussion prior to surgery
with your surgeon about sexual activity expectations so that you can
better understand the likelihood of having your expectations met or
potentially tempering expectations after surgery."
SOURCE: http://bit.ly/2qrBwqI Clinical Orthopaedics and Related
Research, online November 1, 2019.
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