Comparing Outcomes in Sexual Function After Total Hip and Knee Arthroplasty: A Systematic Review.

Abstract

Sexual function is an important contributor to quality of life for people undergoing lower-limb arthroplasty, yet it is rarely discussed in clinics and inconsistently measured in research. Evidence suggests improvement after surgery, but findings are scattered across hips and knees, instruments vary, and a direct joint-wise comparison is lacking. This review compares sexual outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA) across three prespecified domains: return to sexual activity (RTSA), frequency of sexual activity (FSA), and sexual satisfaction or fulfillment of preoperative expectations (SS). A systematic search of major biomedical databases and trial registries was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies reported on sexual function after primary THA or TKA, specifically RTSA, FSA, or SS. There were two independent reviewers who screened, extracted, and assessed the risk of bias. There were 27 studies, including 9,267 patients (5,350 THA, 3,917 TKA), that were eligible. The RTSA tended to be earlier following TKA compared with THA; however, through exploratory pooling, a greater proportion of THA patients reported higher SS (75.4%, 703 of 932) than TKA patients (69.3%, 843 of 1,216; P = 0.0013) and demonstrated greater increases in FSA (P < 0.001). Study quality was variable, with marked heterogeneity in methodology and outcome measures. Arthroplasty improves sexual function, but recovery patterns differ: TKA patients return earlier, while THA patients achieve greater gains in frequency and satisfaction. These differences have important implications for counseling and expectation setting. Progress in this field requires standardized, validated instruments and high-quality prospective studies.