Patients who’ve had a knee or a hip replaced report an improved sex life after surgery, according to new research presented as a poster at the American Academy of Orthopaedic Surgery (AAOS) annual meeting in Chicago.

Doctors rarely ask arthritis patients about sex. Yet research shows that joint pain and stiffness can have a profound effect on physical and emotional intimacy. For example, in a British study, published in the journal Rheumatology in 2002, more than half of respondents said arthritis pain reduced their ability to experience or enjoy lovemaking, and for many, relationships, self-esteem and self-identity also suffered.

To learn more about the effect of total knee and hip replacement surgery on sexual function and emotional well-being in people with severe osteoarthritis, or OA, researchers at Lenox Hill Hospital in New York undertook a study.

"Other studies [on this subject] have been retrospective – asking patients about postoperative function," says senior study author José A. Rodriguez, MD, director of Lenox Hill Hospital's Center for Joint Preservation and Reconstruction. "The quality of what we did lies in its prospective nature, looking at patients both before and after surgery. We also wanted to understand not just positional issues, but also emotional ones."

Dr. Rodriguez and colleagues invited nearly 400 patients to participate anonymously in the study. Close to 150 responded by returning preoperative questionnaires. Of these, 116 also returned postoperative questionnaires and 65 submitted 6-month and 1-year reports. Patients ranged in age from 35 to 70; slightly more women than men responded.

Before surgery, 67 percent of patients reported problems with sexual function, including joint pain and stiffness, lowered libido and trouble achieving the proper position. More than 90 percent reported psychological issues related to their sexual self-image and well-being.

Dr. Rodriguez says neither result was unexpected, pointing out that arthritis-related limitations clearly have both physical and emotional consequences. “When people can't rotate their hips without pain, it's bound to affect sexual function," he notes. "And since these patients tend to be older with less estrogen and testosterone, sexuality is less frankly hormonal and instead has a greater emotional aspect to it."