Sexual Activity in Patients with Femoroacetabular Impingement: Narrative Review of the Literature

Abstract

Introduction Femoroacetabular impingement (FAI) is a common cause of hip pain in young patients, affecting deep flexion and rotation movements, including sexual activity (SA). This study aimed to synthesize the evidence on SR in patients with FAI.

Methods A narrative review of the literature was performed in the Pubmed, Scielo, PEDro, and Epistemonikos databases. Primary studies on sexual relations in patients with FAI were included.

Results Seven papers published between 2014-2024 on SR in patients with FAI were found. In the published studies, difficulties in SR associated with FAI have been described in 61-91% of patients, with the main causes being pain and stiffness, which began one to two months after symptoms. Post-surgical improvements have been described in 29-89% of patients, with a resumption of sexual activity between 29-48 days. No evidence was found regarding traumatologists' assessment of sexual activity in patients with AFP in clinical practice (e.g., frequency, difficulty, pain, etc.). Finally, there is little evidence regarding specialists' education of patients about sexual relations.

Conclusion FAI significantly impacts sexual activity, with improvements reported after arthroscopy in a group of patients. SR is a topic rarely addressed by surgeons, both in the evaluation of patients and in their education.

Level of evidence: V

Keywords

Femoroacetabular impingement - Sexual Activity - Sexual Behavior - Sexual Function

Publication History

Received: 27 September 2024

Accepted: 21 March 2025

Article published online:
20 May 2025

• Referencias

• 1 Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003; (417) 112-120 https://journals.lww.com/00003086–200312000–00013
• 2 Bozic KJ, Chan V, Valone III FH, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. J Arthroplasty 2013; 28 (8, Suppl) 140-143
• 3 Harris JD, Erickson BJ, Bush-Joseph CA, Nho SJ. Treatment of femoroacetabular impingement: a systematic review. Curr Rev Musculoskelet Med 2013; 6 (03) 207-218
• 4 Collins JA, Ward JP, Youm T. Is prophylactic surgery for femoroacetabular impingement indicated? A systematic review. Am J Sports Med 2014; 42 (12) 3009-3015
• 5 Griffin DR, Dickenson EJ, Wall PDH. et al; FASHIoN Study Group. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 2018; 391 (10136): 2225-2235
• 6 Frank JM, Harris JD, Erickson BJ. et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. J Arthroplasty 2015; 31 (06) 1199-1204
• 7 Mascarenhas VV, Rego P, Dantas P. et al. Imaging prevalence of femoroacetabular impingement in symptomatic patients, athletes, and asymptomatic individuals: A systematic review. Eur J Radiol 2016; 85 (01) 73-95
• 8 Parvizi J, Leunig M, Ganz R. Femoroacetabular impingement. J Am Acad Orthop Surg 2007; 15 (09) 561-570
• 9 Hunt D, Prather H, Harris Hayes M, Clohisy JC. Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders. PM R 2012; 4 (07) 479-487
• 10 Emara K, Samir W, Motasem H, Ghafar KAEL. Conservative treatment for mild femoroacetabular impingement. J Orthop Surg (Hong Kong) 2011; 19 (01) 41-45
• 11 Matsumoto K, Ganz R, Khanduja V. The history of femoroacetabular impingement. Bone Joint Res 2020; 9 (09) 572-577
• 12 Sochacki KR, Yetter TR, Morehouse H, Delgado D, Nho SJ, Harris JD. The Risk of Impingement With Sexual Activity in Femoroacetabular Impingement Syndrome Due to Cam Morphology: Shape Matters. Orthop J Sports Med 2018; 6 (08) 2325967118791790
• 13 Lee S, Frank RM, Harris J. et al. Evaluation of Sexual Function Before and After Hip Arthroscopic Surgery for Symptomatic Femoroacetabular Impingement. Am J Sports Med 2015; 43 (08) 1850-1856
• 14 Kierkegaard S, Langeskov-Christensen M, Lund B. et al. Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis. Br J Sports Med 2017; 51 (07) 572-579
• 15 Meiri R, Rosenbaum TY, Kalichman L. Sexual Function before and after Total Hip Replacement: Narrative Review. Sex Med 2014; 2 (04) 159-167
• 16 Charbonnier C, Chagué S, Ponzoni M, Bernardoni M, Hoffmeyer P, Christofilopoulos P. Sexual activity after total hip arthroplasty: a motion capture study. J Arthroplasty 2014; 29 (03) 640-647
• 17 Laffosse JM, Tricoire JL, Chiron P, Puget J. Sexual function before and after primary total hip arthroplasty. Joint Bone Spine 2008; 75 (02) 189-194
• 18 Ugwuoke A, Syed F, Hefny M, Robertson T, Young S. Discussing sexual activities after total hip arthroplasty. J Orthop Sci 2020; 25 (04) 595-598
• 19 Bonilla G, Asmar MA, Suarez C, Barrios V, Suarez MA, Llinás A. The impact of total hip arthroplasty on sexual satisfaction in female patients: a prospective before-and-after cohort study. Int Orthop 2021; 45 (11) 2825-2831
• 20 Kopec JA, Hong Q, Wong H. et al; IMPAKT-HIP Study Team. Prevalence of femoroacetabular impingement syndrome among young and middle-aged white adults. J Rheumatol 2020; 47 (09) 1440-1445
• 21 Van Houcke J, Yau WP, Yan CH. et al. Prevalence of radiographic parameters predisposing to femoroacetabular impingement in young asymptomatic Chinese and white subjects. J Bone Joint Surg Am 2015; 97 (04) 310-317
• 22 Laborie LB, Lehmann TG, Engesæter IØ, Engesæter LB, Rosendahl K. Is a Positive Femoroacetabular Impingement Test a Common Finding in Healthy Young Adults?. Clin Orthop Relat Res 2013; 471 (07) 2267-2277 https://journals.lww.com/00003086-201307000–00035 [Internet]
• 23 Ochoa LM, Dawson L, Patzkowski JC, Hsu JR. Radiographic prevalence of femoroacetabular impingement in a young population with hip complaints is high. Clin Orthop Relat Res 2010; 468 (10) 2710-2714
• 24 Raut S, Daivajna S, Nakano N, Khanduja V. ISHA-Richard Villar Best Clinical Paper Award: Acetabular labral tears in sexually active women: an evaluation of patient satisfaction following hip arthroscopy. J Hip Preserv Surg 2018; 5 (04) 357-361
• 25 Alkan H, Erdoğan Y, Veizi E. et al. Better sex after hip arthroscopy; Sexual dysfunction in patients with femoro-acetabular impingement syndrome. Orthop Traumatol Surg Res 2025; 111 (03) 103693
• 26 Smith C, Nero L, Holleyman R, Khanduja V, Malviya A. Hip Arthroscopy for Femoroacetabular Impingement Is Associated With Improved Sexual Function And Quality of Life. Arthroscopy 2024; 40 (08) 2204-2212
• 27 Rynecki ND, Kingery MT, DeClouette B. et al. Hip Arthroscopy Improves Sexual Function in Receptive Partners with Femoroacetabular Impingement Syndrome. Clin Orthop Relat Res 2024; 482 (08) 1455-1468
• 28 Morehouse H, Sochacki KR, Nho SJ, Harris JD. Gender-Specific Sexual Activity After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Position Matters. J Sex Med 2020; 17 (04) 658-664
• 29 Vidal C, Lira MJ, Besa P, Carmona M, Irarrázaval S. Validación de medidas de resultados informados por los pacientes en Ortopedia y Traumatología. Rev Chil Ortoped Traumatol 2022; 63 (01) e55-e62
• 30 Ruiz-Ibán MA, Seijas R, Sallent A. et al. The international Hip Outcome Tool-33 (iHOT-33): multicenter validation and translation to Spanish. Health Qual Life Outcomes 2015; 13 (01) 62
• 31 Griffin DR, Parsons N, Mohtadi NGH, Safran MR. Multicenter Arthroscopy of the Hip Outcomes Research Network. A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice. Arthroscopy 2012; 28 (05) 611-616 , quiz 616–618
• 32 Mohtadi NGH, Griffin DR, Pedersen ME. et al; Multicenter Arthroscopy of the Hip Outcomes Research Network. The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33). Arthroscopy 2012; 28 (05) 595-605 , quiz 606–10.e1
• 33 Raut S, Kamal J, Norrish A, Khanduja V. The impact of acetabular labral tears on sexual activity in women. J Hip Preserv Surg 2019; 6 (04) 301-303
• 34 Harmsen RTE, Nicolai MPJ, Den Oudsten BL. et al. Patient sexual function and hip replacement surgery: A survey of surgeon attitudes. Int Orthop 2017; 41 (12) 2433-2445
• 35 Neonakis EM, Perna F, Traina F. et al. Total hip arthroplasty and sexual activity: a systematic review. Musculoskelet Surg 2020; 104 (01) 17-24 Springer PubMed
• 36 Issa K, Pierce TP, Brothers A, Festa A, Scillia AJ, Mont MA. Sexual Activity After Total Hip Arthroplasty: A Systematic Review of the Outcomes. J Arthroplasty 2017; 32 (01) 336-340 Churchill Livingstone Inc.
• 37 Dahm DL, Jacofsky D, Lewallen DG. Surgeons rarely discuss sexual activity with patients after THA: a survey of members of the American Association of Hip and Knee Surgeons. Clin Orthop Relat Res 2004; (428) 237-240
• 38 Bell E, Mosler A, Barton C. et al. What are participant beliefs regarding physical therapy led treatment? A qualitative study of people living with femoroacetabular impingement syndrome. Braz J Phys Ther 2024; 28 (03) 101077
• 39 Kiapour AM, Otoukesh B, Hosseinzadeh S. The Readability of Online Educational Materials for Femoroacetabular Impingement Syndrome. J Am Acad Orthop Surg 2021; 29 (11) e548-e554
• 40 MacLeod MG, Hoppe DJ, Simunovic N, Bhandari M, Philippon MJ, Ayeni OR. YouTube as an information source for femoroacetabular impingement: a systematic review of video content. Arthroscopy 2015; 31 (01) 136-142 W.B. Saunders