Sex after a hip or knee replacement: when it is usually safe and how to ease back in

Sex is not forbidden after a hip or knee replacement, and for most people the question is when it feels comfortable and which positions are safe. The published guidance is not identical. For a hip replacement the NHS advises trying to avoid sex for 6 to 8 weeks after the operation. Arthritis UK says you will probably be able to have sex after about six to eight weeks. For a knee replacement, the sources read for this page do not give a waiting time.

A Worcestershire hip leaflet takes a looser line, saying you may resume sexual activities as soon as you feel ready. The difference matters: hospitals vary in how strictly they apply hip precautions. If you were given a written precautions sheet, that sheet is the one to follow, and your surgeon or therapist can say whether it applies to intimacy.

The NHS page on recovering from a hip replacement lists, among its do's, trying to avoid sex for 6 to 8 weeks after your operation. In its list of don'ts it says not to bend the hip more than 90 degrees (a right angle), not to bend down to touch your feet or ankles, and not to sit in a low chair or toilet seat. It also says not to sit with the legs crossed. Those movement limits are the reason positions matter.

Arthritis UK says you need to take care, especially during the first eight to 12 weeks after the operation, to avoid dislocating the hip. You may not be able to bend your leg towards your body as far as you would like to, and you should not test the new joint to see how far it will go. On sex itself it says you will probably be able to have sex after about six to eight weeks, that many people find it more comfortable to lie on their back, and that you should not feel awkward about asking for advice on suitable positions.

The Worcestershire leaflet adds that you may find certain positions more comfortable and that it can help to let your partner take an active role. Taken together, the common thread is to keep the operated hip from bending deeply or twisting, and to let comfort set the pace.

The knee sources are shorter. The NHS knee recovery page does not mention sex. The Royal National Orthopaedic Hospital guide, which covers hip and knee together, says that unless you find it painful, or your surgeon advises you otherwise, it is safe to continue sexual relations with your partner, and that you can discuss this further with the therapy team.

The same guide says kneeling is not advisable for several months after a knee replacement, and the NHS says not to kneel on the new knee until your doctor says you can. Positions that put weight through the front of the knee are therefore the ones to avoid early on. The NHS also advises avoiding twisting the knee, and Arthritis UK says to take care not to twist as you turn. Those cautions cover movement in general and are a reasonable guide to which positions will feel comfortable.

There is no knee-specific figure in the published sources, so there is no reason to apply the hip figure of 6 to 8 weeks. Pain, swelling and stiffness are the practical limits. Arthritis UK notes that swelling is very common after a knee replacement and may last up to three months or so, and that pain from bruising is normal in the first two months.

Comfort first. Pain is a signal to change position or stop. Both the hip and the knee sources describe recovery in terms of what feels comfortable, with no hard rule beyond the surgeon's precautions.

Support helps. Pillows under or between the legs are widely used in hip recovery. Arthritis UK describes sleeping on your back at first with a pillow or support between the legs to keep them stable after a hip replacement, and the same approach can be applied to resting positions. The NHS says you do not need a special sleeping position after a knee replacement but not to put a pillow under the knee, and the same caution is relevant for the knee during intimacy.

Talk to your partner. Worry about hurting the joint can be as much of a limiter as the physical restrictions. The Royal National Orthopaedic Hospital says you can discuss sexual relations with the therapy team, and Arthritis UK says not to feel awkward about asking.

Go gently with energy. Fatigue after major surgery is normal, and the NHS says that recovery from a knee replacement may take several months or longer and from a hip replacement several months. Sex does not need to be on any particular schedule.

The pages read for this page do not list the warning signs of a dislocated hip, so the precautions sheet from your own hospital is the place to find them. Ask your team what to do and whom to call if you are worried between appointments.

Arthritis UK lists signs of infection to report to your GP or hospital: breakdown of the wound with oozing, pus or sores, increased pain, and redness with the area feeling warmer than usual or smelling unpleasant. It also says that pain or swelling in the leg after surgery may be a sign of a blood clot and is a reason to seek medical advice straight away.

If intimacy continues to be painful, or you are worried about it after the usual recovery period, say so at your follow-up. The NHS follow-up is about 6 weeks after a knee replacement and around 6 to 12 weeks after a hip replacement.