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Patients experience mixed results with respect to sexual quality and frequency after total knee arthroplasty: a systematic review
  1. Gregory S Kazarian,
  2. Antonia F Chen
  1. Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Antonia F Chen, Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 125 S 9th Street, Suite 1000, Philadelphia, PA 19107, USA; Antonia.Chen{at}


Importance There are limited data describing the impact of total knee arthroplasty (TKA) on postoperative sexual activity. This lack of information may lead to inaccurate preoperative expectations and predispose patients to dissatisfying outcomes with respect to sexual activity.

Objective The objective of this systematic review was to determine: (1) How important is sexual activity to patients undergoing TKA? (2) How will TKA impact a patient’s postoperative sexual activity?

Evidence review We performed a comprehensive search using PubMed, Scopus and Ovid databases to identify literature relevant to sexual activity following TKA. Publications were identified and sorted using our inclusion/exclusion criteria. Data were normalised and segregated for qualitative description.

Findings We identified eight studies that met our inclusion/exclusion criteria. Patient populations, study objectives and findings varied greatly between studies. With respect to the importance of sexual activity among patients undergoing TKA, results were highly polar, with some studies indicating that sexual activity was among the most important activities, and others reporting it among the least important. With respect to the ability to return to sexual activity after TKA, patients listed engaging in sex as one of the least difficult activities postoperatively, and fewer patients had to adjust their sexual positions to accommodate their knee. About 50%–77% of patients experienced no change in the quality/frequency of sex as a result of TKA, 6%–44% experienced an increase, 6%–32% reported decreases and 2%–23% experienced a cessation of sexual activity. However, outcomes with respect to sexual activity often failed to meet patients’ preoperative expectations.

Conclusions and Relevance Studies reporting on the US population with representative male/female distributions reported that sexual activity was highly important to patients, although this finding may not be globally generalisable. While data regarding changes in sexual quality/frequency are variable, studies with longer average follow-up time and younger patient populations tended to report better outcomes. These results likely indicate that younger populations will experience more favourable changes in sexual activity as a result of TKA, and that improvements in sexual quality/frequency will continue as follow-up time increases. Furthermore, patients undergoing TKA are likely to return to sexual activity at 2.4months.

Level of evidence Level III.

  • Knee (Anatomic Location)
  • Rehabilitation/Physical Therapy (Orthopaedic Sports Medicine)
  • Arthroplasty (Treatment/Technique)
  • Total Joint Replacement (Treatment/Technique)

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  • Contributors Both authors have contributed substantially to this manuscript.

  • Competing interests None declared.

  • Competing interests Commissioned; externally peer reviewed.

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