The postoperative responses were more surprising. Ninety percent of patients who underwent either knee or hip replacement surgery reported improved overall sexual function; improvement was greater after hip replacement compared to knee replacement, and a higher number of women reported benefits than men. Forty-two percent of participants reported a stronger libido and 41 percent reported increased frequency of intercourse. Sixteen percent of study participants however reported the surgery had a dampening effect on intimacy, with 10 percent saying they feared sex would damage the implant. Further, 84 percent of patients noted an increase in general well-being and 55 percent in sexual self-image.
 
"One thing that surprised me was the large improvement in self-esteem and well-being; that's really quite impressive," Dr. Rodriguez says, adding that it's possible the answers were influenced by the setting or phrasing of the questions.

Still, he says arthritis-related sexual dysfunction can cause great emotional suffering, citing a patient he met as an orthopaedic fellow.

"She had severe arthritis that required her to use a wheelchair, and she was hoping to undergo hip replacement surgery," Dr. Rodriguez says. "My mentor turned her down because she was so young. Hearing this, she started crying. 'You have no idea how it affects me not to be able to make love to my husband,’ she said. ‘Please give me the opportunity to make love to my husband.' That really influenced me. The issue is always in my mind, and I bring it up with more and more patients."

He sees the current study as a way to ease into a discussion of sexuality with future patients, though he's uncertain it will prompt other physicians to do the same. "This is something that isn't talked about and needs to be," he says.

"We inflicted them with that restriction," Dr. Rodriguez says. "We need to explain to patients that what they do in the postoperative period depends on their comfort – whether it's exercise or intimacy – and that it's safe to participate in these things."

Jeffrey N. Katz, MD, director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital in Boston and a professor of medicine and orthopaedic surgery at Harvard Medical School, notes that the results of the current study "align with other studies showing that advanced arthritis of the lower extremity may be associated with impaired sexual function in many patients."

But he adds, "This study also suggests that joint replacement results in improvement in sexual function. The very low response rates raise the possibility that the results of the study are biased [and] more rigorous studies addressing this important question are warranted."

Dr. Rodriguez agrees that the study numbers are small but says they are in line with those of similar studies. "When we ask strictly orthopaedic questions, we get better responses," he says.