Every joint replacement patient leaves my office with a plan. When to walk, how to ice, when to drive, when to come back. We talk about stairs, showers, sleep, and the first night home. What most of them do not leave with is an answer to a question they are thinking about and almost never ask: When can I have sex again?
They don’t ask, and too often we don’t offer. A review of the published studies found that 86 percent of surgeons rarely or never discuss sexual activity with their hip replacement patients. That silence has a cost. In the same review, 76 percent of patients identified their hip arthritis as the main cause of their sexual problems. Arthritis does not just take away long walks and a good night’s sleep. For many couples it quietly takes away intimacy too, sometimes for years before surgery.
So when a patient gets a new hip or knee, part of what we are giving back is that part of their life. It seems strange to hand them a detailed plan for the stairs and say nothing about the bedroom.
I think part of the reason surgeons avoid the topic is that the old answer was complicated. For decades, hip replacement recovery came with a long list of rules designed to prevent dislocation: Don’t bend past 90 degrees, don’t cross your legs, sleep with a wedge pillow, wait six weeks or longer. Much of the published advice on sex after hip replacement grew up in that era, including a well-known 2014 motion-capture study that modeled twelve positions on hip implants and flagged the ones that required deep hip bending or extreme rotation. That work was useful. It was also done with two volunteers and computer models, and it reflects a more restrictive way of thinking than many of us practice today.
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Here is what changed. Most of my hip replacements are done through the anterior approach, and after that surgery the precautions are far simpler. The single rule I give is to avoid the extremes of motion. There is no six-week clock. For those patients, the honest answer to “When can we resume?” is whenever it is comfortable. Let pain be your guide. Early on, positions where the person who had surgery can stay more passive, lying on their back, for example, are usually the easiest.
That does not mean every patient gets the same answer. After a posterior hip replacement, the precautions matter more, especially early, and following your surgeon’s specific instructions is the whole game. That is exactly why the conversation has to happen: A patient cannot follow advice nobody gave them, and the right advice depends on how their surgery was done.
Knees are a different story. There is more swelling and stiffness after a knee replacement, but far less risk. The implant is not the limit; comfort is. Many knee patients spent years unable to kneel, and they assume they never will again. In fact, once the incision has fully healed, kneeling will not damage the implant, even if it feels strange at first. A survey of knee replacement patients found that after the first year, 60 percent said intimacy was easier than the year before.
None of this requires a long appointment. It requires about two minutes and a willingness to raise it first, in the same plain voice we use for driving and stairs. The answer I give comes down to three things. First, whenever it is comfortable is a real answer. Second, if you had a hip replacement, know which approach was used, and ask. Third, and most important, talk to your partner. This should never become a pressure situation, and nobody should end up in an uncomfortable position because it felt easier not to talk about it.
To make it easier, I wrote a two-page guide for patients that covers timing, what the hip approach changes, the knee, and when to call, with simple drawings of which hip angles to avoid early on. It is free to download and share. The longer version is on my website.
We spend a great deal of effort measuring how well patients walk after a joint replacement. We should spend two minutes making sure they know they can get the rest of their life back too.
Disclosure: Dr. Calendine is a paid consultant for Stryker and uses Stryker’s robotic system in knee replacement surgery.
Cory Calendine is an orthopedic surgeon specializing exclusively in hip and knee replacement at the Bone and Joint Institute of Tennessee in Franklin, Tennessee, and is affiliated with Williamson Health. He performs more than 700 joint replacements each year. His clinical interests include surgical technology, including robotics, minimally invasive techniques such as the anterior approach for hip replacement and the subvastus approach for knee replacement, pain management strategies, and optimizing patient outcomes.
Dr. Calendine speaks regularly, nationally and internationally, on joint replacement and has been recognized as a Castle Connolly Top Doctor from 2018 through 2025. He is the founder of Bone Doctor, a patient education YouTube channel with nearly 600,000 subscribers dedicated to helping patients understand arthritis, joint replacement surgery, and recovery. He is committed to advancing patient education, surgical innovation, and the pursuit of better outcomes in hip and knee replacement.
He shares professional updates through his website, LinkedIn, Instagram, Facebook, and X. His academic work is also listed on Google Scholar and ORCID.
