2015 ISAKOS Biennial Congress ePoster #901

Evaluation of Sexual Function Before and After Hip Arthroscopy for Symptomatic Femoroacetabular Impingement

Simon Lee, MD, MPH, Ann Arbor, MI UNITED STATES
Rachel M. Frank, MD, Aurora, CO UNITED STATES
Joshua D Harris, MD, Sugar Land, TX UNITED STATES
Charles A. Bush-Joseph, MD, Chicago, IL UNITED STATES
Michael J. Salata, MD, Chicago, IL UNITED STATES
Shane J Nho, MD, MS, Chicago, IL UNITED STATES
Rush University Medical Center, Chicago, IL, USA

FDA Status Not Applicable

Summary: This study highlights the prevalence of sexual difficulties among patients undergoing hip arthroscopy for symptomatic femoroacetabular impingement and the significant impact these difficulties may have on quality of life.

Abstract:

Introduction

Femoroacetabular impingement (FAI) can cause hip pathology which may lead to difficulties in sexual functioning. As the symptomatic FAI patient population consists primarily of younger adults, these difficulties may be significant. Hip arthroscopy as a treatment for symptomatic FAI has been very effective, however, sexual functioning before or after hip arthroscopy has not been reported in the orthopaedic literature. The objective of this study was to evaluate alterations of sexual activity due to FAI and the efficacy of hip arthroscopy to alleviate these symptoms.

Methods

A 23-item Likert-style questionnaire about pre- and post-operative sexual function was sent to 305 patients who underwent hip arthroscopy for FAI by a single fellowship-trained surgeon. Inclusion criteria included all patients between ages 18 to 65 with at least 1 year follow-up. A modified Harris Hip Score (mHHS) outcome measure was included. Analysis was also made after stratifying for gender and age. Continuous variables were compared using independent samples T-test and nominal variables were compared with a chi-squared or Fisher exact test.

Results

131 patients returned the questionnaire for a response rate of 38%. Pre-operative sexual difficulties were reported by 66.3% of patients with difficulties occurring 30.8±49.1 days after the onset of FAI symptoms. 68.1% of patients attributed pain as the primary cause of difficulty, followed by 37.4% reporting stiffness, and 16.8% reporting loss of libido. Pain as a cause of sexual difficulty was a significantly more likely in young patients (p=0.017). 84% experienced relief of pain after arthroscopy and 79% denied current sexual difficulties. In fact, 67% report sex currently being enjoyable. Resumption of sexual activity occurred on average 29.0±20.1 days after arthroscopy while sex with minimal pain occurred in 49.8±40.6 days. Changes to normal sexual positioning were required by 38.6%. Females resumed sexual activity significantly later than men (F: 34.8±23.2 days vs. M: 21.0±10.7 days, p<0.0001) and they were more likely to require a change in sexual positioning (p=0.006). In relation to post-operative sexual frequency, 32.1% increased, 48.1% had no change, 16.8% decreased, and 2.3% have not resumed sexual activity. Sexual difficulties were responsible for relationship tension in 17%. In seeking information about sexual function, 79% patients prefer

Discussion

with their surgeon and 67% would like a booklet on the subject. 41% would like their partner to be present for the discussion, 29% would like them to have the booklet, and only 4% would like them to be interviewed separately. Females were more likely to want their partners to be present during the discussion with the surgeon (p=0.02) as well as receiving the booklet (p=0.01).

Discussion

and Conclusions: Issues of sexual functioning are often overlooked in orthopaedics. Our study highlights the prevalence of sexual difficulties among patients undergoing hip arthroscopy for FAI and the significant impact these difficulties may have on quality of life. While further studies are required to elucidate what specific factors are associated with sexual difficulties, our data suggests that this is an important topic to explore.