Sexual Activity After Total Hip Arthroplasty: A Motion Capture Study

Published:September 09, 2013DOI:


      Relative risk of impingement and joint instability during sexual activities after total hip arthroplasty (THA) has never been objectively investigated. Hip range of motion necessary to perform sexual positions is unknown. A motion capture study with two volunteers was performed. 12 common sexual positions were captured and relevant hip joint kinematics calculated. The recorded data were applied to prosthetic hip 3D models to evaluate impingement and joint instability during motion. To explore the effect of acetabular component positioning, nine acetabular cup positions were tested. Four sexual positions for women requiring intensive flexion (> 95°) caused prosthetic impingements (associated with posterior instability) at 6 cup positions. Bony impingements (associated with anterior instability) occurred during one sexual position for men requiring high degree of external rotation (> 40°) combined with extension and adduction at all cup positions. This study hence indicates that some sexual positions could be potentially at risk after THA, particularly for women.


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        • Currey H.
        Osteoarthritis of the hip joint and sexual activity.
        Ann Rheum Dis. 1970; 29: 488
        • Lafosse J.M.
        • Tricoire J.L.
        • Chiron P.
        • et al.
        Sexual function before and after primary total hip arthroplasty.
        Joint Bone Spine. 2008; 75: 189
        • Stern S.H.
        • Fuchs M.D.
        • Ganz S.B.
        • et al.
        Sexual function after total hip arthroplasty.
        Clin Orthop Relat Res. 1991; 269: 228
        • Wiklund I.
        • Romanus B.
        A comparison of quality of life before and after arthroplasty in patients who had arthrosis of the hip joint.
        J Bone Joint Surg Am. 1991; 73: 765
        • Baldursson H.
        • Brattstrom H.
        Sexual difficulties and total hip replacement in rheumatoid arthritis.
        Scand J Rheumatol. 1979; 8: 214
        • Todd R.C.
        • Lightowler C.D.
        • Harris J.
        Low friction arthroplasty of the hip joint and sexual activity.
        Acta Orthop Scand. 1973; 44: 690
        • Dahm D.L.
        • Jacofsky D.
        • Lewallen D.G.
        Surgeons rarely discuss sexual activity with patients after THA: a survey of members of the American Association of Hip and Knee Surgeons.
        Clin Orthop Relat Res. 2004; 428: 237
        • Nadzadi M.E.
        • Pedersen D.R.
        • Yack H.J.
        • et al.
        Kinematics, kinetics, and finite element analysis of commonplace maneuvers at risk for total hip dislocation.
        J Biomech. 2003; 36: 577
        • Patel A.B.
        • Wagle R.R.
        • Usrey M.M.
        • et al.
        Guidelines for implant placement to minimize impingement during activities of daily living after total hip arthroplasty.
        J Arthroplasty. 2010; 25: 1275
        • Pedersen D.R.
        • Callaghan J.J.
        • Brown T.D.
        Activity-dependence of the “safe zone” for impingement versus dislocation avoidance.
        Med Eng Phys. 2005; 27: 323
        • Kolo F.C.
        • Charbonnier C.
        • Pfirrmann C.W.A.
        • et al.
        Extreme hip motion in professional ballet dancers: dynamic and morphologic evaluation based on MRI.
        Skeletal Radiol. 2013; 42: 689
        • Schmid J.
        • Kim J.
        • Magnenat-Thalmann N.
        Robust statistical shape models for MRI bone segmentation in presence of small field of view.
        Med Image Anal. 2011; 15: 155
        • Pfirrmann C.W.A.
        • Mengiardi B.
        • Dora C.
        • et al.
        Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients.
        Radiology. 2006; 240: 778
        • Reynolds D.
        • Lucas J.
        • Klaue K.
        Retroversion of the acetabulum, a cause of hip pain.
        J Bone Joint Surg Am. 1999; 81: 281
        • Wiberg G.
        The anatomy and roentgenographic appearance of a normal hip joint.
        Acta Chir Scand Suppl. 1939; 83: 7
        • Lequesne M.
        • Seze S.
        The false-profile view of the hip: new radiographic method of the hip evaluation and the utility for the diagnosis of the dysplasia and different coxopathy.
        Rev Rhum. 1961; 28: 643
        • Nötzli H.P.
        • Wyss T.F.
        • Stöcklin C.H.
        • et al.
        The contour of the femoral head–neck-junction as a predictor for the risk of anterior impingement.
        J Bone Joint Surg Br. 2002; 84: 556
        • Tonnis D.
        • Heinecke A.
        Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis.
        J Pediatr Orthop. 1991; 11: 419
        • Rippstein J.
        Determination of the antetorsion of the femur neck by means of two x-ray pictures.
        Z Orthop Ihre Grenzgeb. 1955; 86: 345
        • Charbonnier C.
        • Assassi L.
        • Volino P.
        • et al.
        Motion study of the hip joint in extreme postures.
        Vis Comput. 2009; 25: 873
        • Charbonnier C.
        • Kolo F.C.
        • Duthon V.B.
        • et al.
        Assessment of congruence and impingement of the hip joint in professional ballet dancers.
        Am J Sports Med. 2011; 39: 557
        • Leardini A.
        • Chiari L.
        • Della Croce U.
        • et al.
        Human movement analysis using stereophotogrammetry. Part 3: soft tissue artifact assessment and compensation.
        Gait Posture. 2005; 21: 212
        • Wu G.
        • Siegler S.
        • Allard P.
        • et al.
        ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion — part I: ankle, hip and spine.
        J Biomech. 2002; 35: 543
        • Gilles B.
        • Kolo F.C.
        • Magnenat-Thalmann N.
        • et al.
        MRI-based assessment of hip joint translations.
        J Biomech. 2009; 42: 1201
        • Grood E.S.
        • Suntay W.J.
        A joint coordinate system for the clinical description of three-dimensional motions: application to the knee.
        J Biomech Eng. 1983; 105: 136
        • Lewinnek G.E.
        • Lewis J.L.
        • Tarr R.
        • et al.
        Dislocations after total hip-replacement arthroplasties.
        J Bone Joint Surg Am. 1978; 60: 217
        • D’Lima D.D.
        • Chen P.C.
        • Colwell C.W.
        Optimizing acetabular component position to minimize impingement and reduce contact stress.
        J Bone Joint Surg Am. 2001; 83: 87
        • Malik A.
        • Maheshwari A.
        • Dorr L.D.
        Impingement with total hip replacement.
        J Bone Joint Surg Am. 2007; 89: 1832
        • Widmer K.-H.
        Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty.
        Int Orthop. 2007; 31: S29
        • Stafford G.H.
        • Villar R.N.
        Ischiofemoral impingement.
        J Bone Joint Surg Br. 2011; 93-B: 1300
        • Higa M.
        • Tanino H.
        • Abo M.
        • et al.
        Effect of acetabular component anteversion on dislocation mechanisms in total hip arthroplasty.
        J Biomech. 2011; 44: 1810