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Discussing sex in any amount of detail with a medical professional can be uncomfortable. So much so, it can take mature adults right back to that “sinking in chair” feeling from junior high sex-ed class. Take the topic of sex and add it to the fact that you’ll be undergoing surgery, are in pain, and have likely endured limited mobility for some time, and the topic becomes even more overwhelming. For these reasons, we’ve decided to put together this no-holds-barred post on all things post-op sex. With the guidance of orthopaedic surgeons, Dr. Nima Mehran and Dr. Trevor North, we’ll walk you through some FAQ, break down safe positions for men and women after their replacements, and encourage some Q and A (doctor advised) in our comments section.

Let’s dive in, shall we?

But before we do, it’s worth sharing that majority of patients report that their sex lives improved dramatically after having a hip or knee replacement. In fact, according to a controlled study put out by a group of New York physicians measuring patient sex lives after joint replacement surgery:

  • 42% of post-op patients reported an improvement in libido
  • 36% of patients reported increased intercourse duration
  • 41% of patients reported increased intercourse frequency
  • 55% had improved sexual self-image
  • 84% had improvement in general well-being
  • 90% patients had improved overall sexual function (with a higher rate of improvement for total hip replacement patients).

FAQ: Sex After Joint Replacement Surgery

Q: How long after my joint replacement before I can have sex again?

To put a number to it, some post-op patients report having intercourse as early as the 3-4 week mark. However, there is no concrete answer for when you should first engage in sexual activity. It’s important that you listen to your body, level of desire, and take note of any pain.

A great rule of thumb offered by Dr. Mehran, is “if a patient still needs to use their walker, they’re probably not ready for sex yet.” Requiring a walker is an indicator that your strength and balance isn’t quite optimal yet.

Some key determining factors for your “return to sex rate” are:

  • Whether you’ve had a hip or knee replacement. And for hip replacements, an anterior (replacement done through the front of the hip) versus posterior (through the back of the hip) will have an impact.
  • If you’re having more than one replacement done
  • Any other existing medical conditions
  • Age
  • Pre-surgery libido/sex drive
  • If you’ve done PreHab exercises leading up to surgery to prep your body

Q: Do I need to wait for clearance from my doctor to have sex?

If you’re feeling confident with reduced pain and good balance, there’s no reason to await your doctor’s approval. However, if you’re nervous, approaching the subject with your doctor at your 4-6 week check-up may give you peace of mind. The advice from your doctor will likely resemble the following: listen to your body and perform safe positions for your replacement.

Q: Will my sex life improve after surgery/ when will I regain my desire for sex?

It’s quite likely that you will see some improvements to your sex life. As the study measuring the before and after sex lives of nearly 400 joint replacement patients revealed, 90% had improved overall sexual function. If you haven’t checked out Bonesmart, there are some great forum discussions of patients with first-hand accounts of better sex after surgery.

As for the return of your desire, factors like your age, the extent of your surgery, post-op pain levels and the amount of PreHab you did before the procedure will have an impact. However, once you’re well into recovery, you may just find that you’re libido is heightened and you’re able to to do things in bed you haven’t been able to in years.

Q: Are there positions I should avoid?

Absolutely. For knee replacement candidates, avoiding positions that are uncomfortable, cause pain and involve kneeling or deep knee bending is a must. If you’re having a total knee replacement and listen to your body while treading lightly with your surgical leg, you should have a clear idea of what works and what doesn’t.

On the other hand, post-operative sex for hip replacement candidates is a little more complicated due to the risk of hip dislocations. Read on as we walk you through positions to be avoided for men and women recovering from a total hip regardless of the replacement approach (anterior or posterior).

Q: How can I avoid injury during sex after my surgery?

Knee replacement candidates are more able to avoid the use of their surgical leg during sex, thereby less likely to cause damage. In saying this, knee replacement candidates still must wait they have regained their balance, incisions are healing, pain is reduced and they are feeling confident about some physical activity. For knee replacement patients, letting your body be the guide is generally a solid enough rulebook.

Unfortunately, for hip replacement candidates—especially women—sex may involve a wide range of hip flexion, rotation and extension. Therefore, post-operative sex can be quite dangerous for hip replacement patients if not executed carefully.

Tips to Avoid Injury During Sex:

  • For women with posterior hip replacements, avoid unsafe positions like the plague (see below for a full list). The same goes for men with anterior hip replacement. All other hip replacement patients, male or female, should be careful they do not over-flex and ease slowly into comfortable positions. For knee replacement candidates: engage in sex positions that are low-impact and comfortable.
  • Use pillows or towels to prop you, your surgical leg, or your partner up. Take time to find a comfortable height and slowly get in and out of positions.
  • Relax. If you’re feeling stressed, your body will be stiffer and more susceptible to injury. Stretch before. It may sound a bit ridiculous, but stretching or performing daily rehab exercises 20-30 minutes before the act will improve flexibility, strength, and prep your body.
  • Don’t try too much too soon (this means no hanging from chandeliers or Kama Sutra).

Safe Sex Positions For All Joint Replacement Candidates

sex positions back pain

The below positions are safe for most patients after surgery—regardless if they’ve had a posterior or anterior hip replacement, a knee replacement, or are male or female. These positions should still be approached with caution, while avoiding pressure on the surgical leg and not to breaking the 90 degree angle rule (bringing your knee close to your body).

  1. Missionary Position—This is one of the safest positions for men and women after a hip or knee replacement. The female should assume the bottom position, keeping her legs straight. Pillows can be used to support the surgical leg.
  2. Sitting in a Chair—The man should sit in a firm chair with his feet flat on the floor. The woman then sits on the man’s lap.
  3. Standing Position—This position works for a man or woman. The knee or hip should be healed enough to support sturdy standing.

Sex Positions After a Hip Replacement

It’s REALLY (in a shouting voice) important that those with hip replacements avoid sex positions that require placing their joint in extreme ranges of motion (e.g. crossing one leg over another or bringing a knee to the chest). The directions of motion to avoid depend on whether you’ve had an anterior or posterior hip replacement. The first step is to determine which hip replacement approach you’ve had.

Anterior-A hip replacement done through the front of the hip.

Posterior-A hip replacement done through the back of the hip

Patients who’ve undergone an anterior approach should avoid extremes of extension (leg lifted backwards) and external rotation (foot/knee turned out). Patients who’ve undergone a posterior approach should avoid positions of hyper-flexion (bringing knee towards body) and internal rotation (foot/knee turned in).

Here is a good chart to illustrate the motions to avoid after a hip replacement:

A study in the Journal of Arthroplasty measured hip replacement instability in common sex positions. They found that 25% of common positions require women to over-stretch their hip (past 95 degrees—a sitting position), putting them at serious risk for dislocation and other damage. The same study found that only one of the common positions had the same effect on men recovering from a replacement.

Positions Women with a Posterior Hip Replacement Should Avoid

The following positions are proven to require intensive flexion (over-stretching) of the new hip joint for posterior replacement patients. At greater than 95 degrees, these positions will cause instability and put the woman at risk for dislocation.

  1. Doggy Style—The woman is on her hands and knees and her partner is behind.
  2. L-Shaped Side Sex—The woman is on her back, with her pelvis lifted. Her lower body is turned to the right into her partner.
  3. Face-to-Face Side Sex—Lying on her side the woman wraps her leg on top of her partner.
  4. Woman Crouched on Top—The woman is on top with her legs bent, leaning forward onto the man’s chest.

Women who’ve had an anterior hip replacement (not a posterior) should still exercise caution with the above positions. However, women with an anterior replacement are at a much lower risk for dislocation.

Positions Men with an Anterior Hip Replacement Should Avoid

For men who’ve had a hip replacement, there is only one position that is associated with causing measurable damage. Unlike in women, the measurable damage is contained to those who’ve had an anterior approach, not a posterior.

  1. Face-to-Face Side Sex—Lying on his side the man has his leg wrapped in between his partner’s legs.

Safe Sex Position Chart After a Hip Replacement

Sex Positions After a Knee Replacement

For male and female knee replacement patients, sex positions should be determined by comfort level, pain, and also to avoid kneeling and deep knee bending. Simply, if something is hurting, do not do it. Unlike the hip replacement chart, none of the below positions are dangerous per se but some may be uncomfortable.

This chart outlines positions that may be uncomfortable after a Knee Replacement:

There are countless ways in which your hip or knee replacement will improve your quality of life—your sex life is one of them. Statistically speaking, you should feel more comfortable, capable, and empowered than ever to have great sex after your replacement. Just remember, recovery happens at your own pace and getting back into your sexual groove is no different. Relax, take it slow, be careful, and most importantly, have fun!

Do you have any questions about sex and your joint replacement? Share below to receive real answers by real orthopaedic surgeons.

In pain? Preparing for surgery? PeerWell Health helps you fast forward to better with 1:1 doctor visits, physical therapy, and a custom at-home program for your condition. 

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