Women and Total Hip Replacement

Pregnancy and total hip replacement. What about sex after THR? Osteoporosis after menopause.

What about sex after total hip replacement?
Absolutely. This is, however, an issue that many patients are shy to discuss. Available statistics demonstrate that 20 % of all patients expected an improvement of their sexual life after the total hip replacement, but studies showing how these expectations were fulfilled are still lacking.
Many women express concern about a dislocation or damage to the new hip joint while having intercourse after the total hip operation.

After 8 to 12 weeks a new capsule has grown around the new hip joint and the force has returned to the muscles around the total hip joint. Therefore, after this period the risk of dislocation is low.

Moreover, in patients who were operated on with a posterior or posterolateral access to the hip joint (the most often used operation access to the hip), the risk of total hip dislocation diminishes with the patient lying supine, the hips moderately bent and the knees apart. This is also the usual position for intercourse.
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Pregnancy and total hip replacement

“My doctor said to have my baby first and wait with my hip surgery, the pregnancy might damage a total hip. And how would I catch my daughter, which is so lively baby, with my old aching hips? And how could I have the strength for all other chores with my old stiff hips? They also recommend you to restrict your body weight during pregnancy, to protect your total hip. But how can you do it when the belly is growing?…”

Between 2 to 3 % of all total hip replacements are done on women in fertile age, about one half of these operations are carried out for inflammatory arthritis of the hip joint.

Published studies demonstrate that even women with bilateral total hip replacement may give birth to healthy babies.
The overall function and the X-ray picture of the total hip prosthesis was not affected adversely by successful pregnancy and delivery in these women patients.

One published study showed that during pregnancy the mean weight of the women patients increased with 13 kilograms. This weight increase has had no effect on the total hip prosthesis. All these women have had cementless total hip prostheses, their age ranged from 22 to 38 years.
During pregnancy and for further 3 months after delivery, the range of movements in the operated hip increases considerably (this is the effect of relaxing hormones produced during pregnancy). There is thus increased risk of dislocation of the total hip, although no such complication was published as yet.
The delivery was through cesarean section in the half of all pregnancies in women with total hip replacement. It is recommended that, if possibly, the surgeon who implanted the total hip should be consulted before delivery. (McDowell, 2001)

Osteoporosis after menopause
Studies on women patients with total hip replacement showed, that medication with hormone replacement therapy did not prevent development of osteoarthritis in the hips of these patients. (Erb, 2000)
It is conceivable that the osteoporosis (softening of bone) that develops in women after menopause may increase the rates of total hip failures in these women patients. As yet, there is no convincing proof for this assumption. Neither are there studies investigating the effect of hormone replacement therapy on the rates of failures of total hip replacements in women after menopause.
Diphosphonates are medicines used to mitigate the development of osteoporosis in women after menopause. These medicines are effective to stop the osteolysis (dissolving of bone) around joint prostheses in animal experiments. According to some reports, the diphosphonates can even treat the osteolysis: in some experiments new bone grew into the areas of destructed bone. It is thus conceivable that these medicines might be used for treatment of prosthetic loosening caused by osteolysis. (Millett 2002)
Many female patients with cementless total hips are using Diphosphonates to prevent development of senile osteoporosis. There is a concern that Diphosphonates, who work through slowing bone remodeling may hinder the ingrowth of bone into the surface of cementless total hips. Animal experiments, however, demonstrated that Diphosphonates do not inhibit bone ingrowth into apatite-coated total joint implants. (Mochida 2002).

Gender difference?
Studies demonstrate that women over 65 years of age have already before the total joint surgery more pain and less function in their hip joints than men (Holtzman 2002).

One year after the total hip surgery this difference between women and men persists (Table)

References:

• Holtzman et al: Med Care 2002; 40: 461-70
• McDowell: J Bone Joint Surg-Am, 2001; 83-A: 1490-5.)
• Erb A, et al.: Ann Rheum Dis 2000;59: 105-9)
• Millett PJ et al: J Bone Joint Surg-Am; 2002; 84-A: 236- 49)
• Mochida Y et al: J Bone Joint Surg-Am; 2002; 84-A: 226- 35