Background
Methods
Data sources and searches
Study selection
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Studies describing SQoL in patients with primary and or secondary HA undergoing THR were included if they measured SQoL after or before and after THR; studies that only assessed SQoL before surgery were excluded.
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Homogeneous cohorts of Ankylosing Spondylitis (AS) or Rheumatoid Arthritis (RA) in combination with SQoL were excluded because of the systemic illness and multiple joint involvements interfering with SQoL.
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Studies describing SQoL in patients undergoing THR and Total Knee Replacement (TKR) were excluded if data could not be split up.
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Studies solely assessing expectations about SQoL before and or after surgery were excluded.
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Studies not written in English, German or Dutch were excluded, because of capacity reasons.
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Reviews, editorials, case studies and legal cases were excluded.
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Studies with no full text available through the Dutch Interlibrary Loan System (IBL) were also excluded.
Data extraction
Assessment of methodological quality
Data syntheses
Results
Study characteristics
First author, country | Study design | Aim/Objective | N of patients (Response Rate) | Diagnosis n (%) | Main inclusion criteria | Mean Age (years) | n (%), Male | n (%), Female | Duration of follow up, after surgery |
---|---|---|---|---|---|---|---|---|---|
Todd 1972 UK | Retrospective, cohort studyd Interview (Int) and Survey | Incidence of SD and influence of THR on SQoL | Int: 123/292 (42 %) Surv: 79/134 (58 %) | HAa
| Patients undergone THR with active sexual relationship at time of onset HA; | Interview NA M61 (30–79) F 60 (29–79) | Interview NA 49(40) 36 (46) | Interview NA 74(60) 43 (54) | Int: NA Surv: NA |
Wiklund 1991 Sweden | Case-control study, Survey | To evaluation of QoL before and after THR in patients with HA | 56/57 (98 %)g
| Prim. HA: 40 (71 %) Sec. HA: 16 (29 %) incl 1 RAb
| Patients with HA < 80 year; awaiting THR | 65 (30–79) | 21 (38) | 35 (63) | 1 year |
Stern 1991 USA | Retrospective, cohort study, Survey | To determine the effect of THR on SF incl. sexual positions and resumption SA after THA | 86/100 (86 %) | Prim. HA: 74 (86 %) Sec. HA: 12 (14 %) of which 4 dysplasia and 8 RAb
| Patients with predominantly HA all undergone THR and <70 y, all satisfied about results THR | 57 (20–70) | 39 (45) | 47 (55) | At time postoperative routine visit |
Laupacis 1993 Canada | Prospective, double-blind randomized trial, Survey | Effect of THR on health related QoL | 188/ 251 (75 %) | HAa
| Patients with HA, < 75 years, no severe OA of other hip, no previous THR or THK (knee) < 5 years, nor infectious arthritis | 64 (40–75) | 97 (53) | 91 (47) | 3 months 6 monthsh 1 year 2 year |
Gogia 1994 USA | Prospective cohort study, Survey | Developing evaluation system to assess clinical outcome of THR related to changes in functional status and pain | 22/24 (92 %) | HAa
| Patients with HA, undergoing THR; alert oriented, ambulatory with or without assistive devices | 69,2 (57–86) | 4 (18) | 18 (82) | 3 and 6 monthsh
|
Gosens 2005, The Netherlands | Prospective, multicentre cohort study, Survey | Translating and validating Oxford Hip Score into Dutch | 146/150 (100 %) | Prim. HA: 117 (78 %) Sec. HA: 33 (22 %) | Age >35 year; patients awaiting THR; No systematic illness and physically and mentally suitable, understanding Dutch language | 65 (38–85) | 52 (35) | 98 (65) | 7 weeks, 3 months, 6 monthsh; 1 year; 2 year |
First author, country | Study design | Aim/Objective | N of patients (Response Rate) | Diagnosis n (%) | Main inclusion criteria | Mean Age (years) | n (%), Male | n (%), Feale | Duration of follow up, after surgery |
Laffosse 2007 France | Retrospective, cohort study, Survey | SD in patients before and after THR; receiving sufficient information | 135/346 (39 %) | Prim. HA: 56 (42 %) | <65 year, undergone THR min. 6 months previously; Revision and Femoral Neck Fracture excluded | 51,8 (22–65) | 77 (57) | 58 (43) | ≥6 months |
Sec. HA: 76 (58 %) Incl. 3 RAb
| |||||||||
Wall 2011 UK | Prospective cohort study, Survey | To determine the effect of HA on SQoL and to assess wheter a SQoL is considered in surgical plan | 86/100 (86 %) | Prim. HA: 74 (86 %) | <75 Year, undergoing THR, living with a partner | 62 (48–74) | 39 (45) | 47 (55) | 6 months |
Sec. HA: 12 (14 %) Incl. 3 RAb
| |||||||||
Yoon 2013 Korea | Retrospective, cohort study, face-to-face interview | To determine concerns related to SQoL; to determine changes in SA after THR | 64/512 (13 %) | Prim. HA: 11 (17 %) Sec. HA: 53 (83 %) Incl. 2 RAb, 5 ASd
| Sexual active patients during previous last year, No dislocation, infection or stiffness. | 50e
| 45 (NA) | 19 (NA) | ≥6 months, at routine follow up visit |
Wang 2014 Japan | Prospective, multicentre cohort study, Survey | To evaluate the influence of ONFH and THR on SQoL | 247/300 (82 %) | Sec. HA: all males, ONFH patients (247) | SA married adults, only ONFH males, Age >25- < 60. Excluded severe comorbiditiesf
| 46,8 (34.7–58.9) | 247 (100) | 1 year | |
Nunley 2014 USA | Retrospective multicentre cohort study, Survey | To evaluate SQoL in young active patients following THR. | 791/806 (98 %)c
| Prim. and non inflammentoire Sec. HAa
| ≤60 year; THR and SRA patients, no history postoperative complications UCLA score >6i
| 49,5 (42.3–56.7) | 531 (66) j
| 275 (34) j
| 2,3 years (±0,8) |
Klit 2014 Denmark | Prospective multicentre cohort study, Survey | To explore any -positive or negative- effect THR have had on sexual function, sexual frequency and sexual practice, in younger THR patients | 136/153 (89 %) | Young HAa patients awaiting THR: n86) (Hip Resurfacing: n44) | <60 Year, undergoing primary THR/HR, not suffering from cognitive dysfunction or malignant disease, able to fill in questionnaire | 53 (48–57) | 68 (50) | 68 (50) | 3 months 6 months 1 year h
|
Methodological quality
Study | Selection bias presenta
| Information bias presenta
| Statistical analysis bias presenta
| Total bias Score | Level of Qualityb
|
---|---|---|---|---|---|
Todd et al. 1973 [23] | 1 | 1 | 1 | 3/3 | L |
Wiklund and Romanus 1991 [3] | 0 | 1 | 1 | 2/3 | L |
Stern et al. 1991 [22] | 1 | 1 | 1 | 3/3 | L |
Laupacis et al. 1993 [4] | 0 | 1 | 1 | 2/3 | L |
Gogia et al. 1994 [21] | 1 | 1 | 1 | 3/3 | L |
Gosens et al. 2005 [27] | 0 | 1 | 1 | 2/3 | L |
Laffosse et al. 2008 [26] | 1 | 1 | 1 | 3/3 | L |
Wall et al. 2011 [24] | 0 | 1 | 1 | 2/3 | L |
Yoon et al. 2013 [13] | 1 | 1 | 1 | 3/3 | L |
Wang et al. 2014 [14] | 0 | 0 | 1 | 1/3 | M |
Nunley et al. 2015 [15] | 0 | 1 | 0 | 1/3 | M |
Klit et al. 2015 [25] | 0 | 1 | 1 | 3/3 | L |
Outcomes
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Sexual Dysfunction (SD),
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Sexual Function (SF), and terms categorised as
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Sexual Activity (SA), for example, “coital frequency”, “resuming time of SA”, and “hip interfering with SA”.
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“Need for information” (or “not able to obtain information”),
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“SD was an argument to undergo THR”,
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“Effects on relationship”,
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“Effects on sexual satisfaction”,
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“Effects on sex quality”, and
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“Concerns” (e.g. “concerns from partner”, “fear of dislocation”, “decreased sexual desire”, “arousal difficulty”, “loss of libido”, and “felt hip slipping out” during SA).
Study | Quality level | Physical-Functional Outcomes of SQoL | Psychosocial Outcomes of SQoL | n in study | Pre-operative n | Post-operative n | Pre operative % (n) (score) | Post-operative % (n) (score) | Δ SQoL in % | Directionc of Change |
p value |
---|---|---|---|---|---|---|---|---|---|---|---|
Todd, et al. 1973 [23] | L | SD in Females: None Slight Considerable Intercourse Ended | 123 | 74 | 74 | ᅟ 39(29) 12(9) 16(12) 32(24) | ᅟ 59(44) 15(11) 5(4) 20(15) | ᅟ 20 3 -11 -12 | ᅟ + +/- + + | ||
SD in Males: None Slight Considerable Intercourse ended | 49 | 49 | ᅟ 61(30) 16(8) 8(4) 14(7) | ᅟ 76(37) 12(6) 0(0) 12(6) | ᅟ 15 - 4 - 8 - 2 | ᅟ + + + +/- | |||||
Wiklund and Romanus 1991 [3] | L | SD | 57 | 57 | 56 | 34 | 9 | -25 | + | 0.001 | |
Stern, et al. 1991 [22] | L | SD None Slight Severe Extreme | 86a
| 86 | 83 | ᅟ 14(12) 40(34) 38(33) 8(7) | ᅟ 65(54) 34(28) 1(1) 0(0) | ᅟ 51 - 6 -37 - 8 | ᅟ ++ + + + | <0.001 | |
SF: Coital Frequency per month | 3,3 | 5,7 | 73d
| +++ | <0.001 | ||||||
Laupacis, et al. 1993 [4] | L |
SF: decreased SA (score 0–10; with 0 points being the best score) | 188 | 33b
| 27b
| 74(7,4) | 30(3,0) | −44 | ++ | ||
Gogia, et al. 1994 [21] | L |
Pain during SA (score 1–5; with 5 points being the best score) | 22 | 7 | 7 | 47(2.36) | 100(5) | 53 | ++ | ||
Gosens, et al. 2005 [27] | L |
SD due to hip:
Never Sometimes Often Most of time Always | 150 | 146 | 144 | ᅟ 43(63) 16(23) 6(9) 12(17) 23(33) | ᅟ 78(112) 15(21) 1(1) 4(6) 3(4) | ᅟ 35 - 1 - 5 - 8 -20 | ᅟ + +/- +/- + + | ||
Laffosse, et al. 2008 [26] | L | SD: None: Minimal: Moderate: Severe: Extreme: | 135 | 135 | 89 | ᅟ 30(40) 21(29) 30(40) 16(22) 3(4) | ᅟ 53(47) 21(19) 26(23) 0(0) 0(0) | ᅟ 23 0 - 4 -16 - 3 | ᅟ + +/- +/- + +/- | ||
SD: Females
None: Minimal: Moderate: Severe: Extreme: | 58 | 57 | 42 | ᅟ 14(8) 19(11) 37(21) 25(14) 5(3) | ᅟ 43(18) 19(8) 36(15) 0(0) 2(1) | ᅟ 29 0 -1 -25 - 3 | ᅟ + +/- +/- + +/- | 0.004 | |||
SD: Males
None: Minimal: Moderate: Severe: Extreme: | 77 | 77 | 48 | ᅟ 40(31) 23(18) 25(19) 10(8) 1(1) | ᅟ 60(29) 23(11) 17(8) 0(0) 0(0) | ᅟ 20 0 - 8 -10 - 1 | ᅟ + +/- + + +/- | 0.13 | |||
Wall, et al. 2011 [24] | L | Hip Interfering with SA: | 86 | 71 | 54 | 77(55) | 0(0) | −77 | +++ | ||
Like more information provided: | 55(39) | 83(45) | 28 | + | |||||||
Wang, et.al 2014 [14] | M | Effect on: | |||||||||
SF (scale 0–8; with 0 points being the best score) | 247 | 247 | 247 | 29(2.3) | 23(1.8) | −6 | + | 0.14 | |||
Hip-pain during SA (scale 0–10; with 0 points being the best score) | 65(6.5) | 9(0.9) | −56 | ++ | 0.009 | ||||||
Hip-mobility during SA (scale 1–5; with 5 points being the best score) | 28(1.4) | 82(4.1) | 54 | ++ | 0.012 | ||||||
Effect on: | |||||||||||
Impairment relationship (scale 0–8; with 0 points being the best score) | 66(5.3) | 29(2.3) | −37 | ++ | 0.026 | ||||||
Overall sexual satisfaction patients (scale 1–5; with 5 points being the best score) | 54(2.7) | 94(4.7) | 40 | ++ | 0.018 | ||||||
Overall sexual satisfaction partner (scale 1–5; with 5 points being the best score) | 76(3.8) | 86(4.3) | 10 | + | 0.4 | ||||||
Klit, et al. 2015 [25] | L |
SD due to hip Females (f OHS scale 0–6; with 6 points being the best score) | 136 | 68 | 68 | 67(4.0) | 83(5.0) | 16 | + | 0.008 | |
SD due to hip Males (fOHS scale: 0–6; with 6 points being the best score) | 68 | 68 | 92(5.0) | 100(6.0) | 8 | + | 0.102 | ||||
SF: SA before and at twelve month follow upe
| 136 | 108 | 83 | 100(108) | 100(83) | 0 | +/- |
Study | Quality level |
Physical-Functional Outcomes of SQoL (n in study)
|
Psychosocial outcomes of SQoL (n in study)
| Postoperative n (%) |
p value |
---|---|---|---|---|---|
Todd, et al. 1973 [23] | L | Relief SD: Females (n 32/37)a: Complete Considerable Slight Nil | 4 (13 %) 12 (38 %) 6 (19 %) 10 (31 %) | - | |
Relief SD: Males (n 22/23)b
Complete Considerable Slight Nil | 6 (27 %) 5 (23 %) 2 (9 %) 9 (41 %) | - | |||
(n 60) | Need for more advice | 34 (57 %) | |||
Stern, et al. 1991 [22] | L |
SF: Time to resume (n75/86): 1–2 months ≤1 month ≥2 months Females = males | ᅟ 41(55 %) 8 (11 %) 26 (34 %) males sooner | ᅟ ᅟ ᅟ <0.01 | |
(n 64) | Need for more advice | 57 (89 %) | |||
Argument to undergo THR: | 15 (20 %) | ||||
Laffosse, et al. 2008 [26] | L |
SF: Coital Frequency (n130/135) Increased: Unchanged: Decreased: | 24 (18,5 %) 91 (70 %) 15 (11,5 %) | ||
Increased, more women than men | 0.02 | ||||
Not able to obtain information | 110 (83 %) | ||||
Argument to undergo THR: | 21 (18,5 %) | ||||
SF: Resuming time (n 135) Females (n 58) Males (n 77) Never having resumed again | ᅟ (n77) | 66,5 days (4–365) 87 days (4–365) 54 days (5–210) 3 (2 %) | ᅟ 0.0005 | ||
Wall, et al. 2011 [24] | L |
Overall effect on SA (n 53/86): Much better Better No Change Worse Much worse | 44 (81 %) 9 (17 %) 0 0 0 | ||
Concerns partner: (Fear hurting spouse) | 7/54 (12 %) | ||||
Yoon, et al. 2013 [13] | L | Time to resume SA: (n 64/64) | 6,19 months (3weeks - 48months) | ||
Difficulty with leg positioning (females more than males) | 25 (39 %) | 0.045 # | |||
Changing Sexual Positions (more frequently for patients with diff. leg positioning) | 26 (40,6 %) | <0.01 | |||
- Muscle weakness (Males n 6) | 11 (17,2 %) | ||||
Not able to obtain information | 51/62 (80 %) | ||||
Concerns
- Fear of dislocations Males Females | 33 (51,6 %) 23/45 (51 %) 10/19 (53 %) | ||||
Effect on relationship (males): Lack of understanding spouse | ᅟ 3 (4,7 %) | ||||
Effect on satisfaction:
- Same - Increase - Less | ᅟ 44 (68,8 %) 15 (23,4 %) 5 (7,9 %) | ||||
Satisfaction correlated to stress | ≤stress = ≥satisfaction | 0.03 | |||
Nunley, et al. 2015 [15] | M | SA since surgery (n 791)c
No Sexual Activity (due to operative hip) | 708 (89,5 %) 10 (1,3 %) | # 0.0061 Odds 1.953 | |
Sex Frequency: - Less: - Same: - More: | n 694 31 (4,5 %) 361 (52 %) 302 (43,5 %) | # ‘less’ <0.0001 Odds 0.130 # ‘More’ <0.001 Odds 3.422 | |||
If ‘more’ caused by: - less pain - greater mobility - less apprehension | ᅟ 294 (98 %) 288 (95,4 %) 224 (74,5 %) | ||||
Sex quality compared to 1 month prior surgery - Worse: - Same: - Better: | (n 697) ' 13 (2,2 %) 195 (28 %) 487 (69,9 %) | # ‘Better’ <0.0001 Odds 10.596 | |||
If ‘better’ caused by: - less pain - greater mobility | ᅟ 481 (98,8 %) 458 (94,2 %) | ||||
-less apprehension | 310 (64,2 %) | ||||
Concerns at least one episode
Felt hip slipping-out during SA (instability) | ᅟ 22 (3,1 %) | ||||
Had to limit SA due to operation | 81 (11,6 %) | # <0.0016 Odds 3.150 | |||
Klit, et al. 2015 [25] | L | Time to resume SA (n 136) ≤ 8 weeks > 8 weeks | ᅟ 55/83 (66 %) 10/83 (12 %) | ||
Sexual Frequency: females | 12 % increase 38 % better abilities sexual praxis | ||||
84 % of them experienced associated increased ROM, decreased pain and fear | |||||
Sexual Frequency: males | No changes | ||||
Erectile dysfunction: males | 3/68 (4 %) |