Weber Patrick, Schmidutz Florian, Ficklscherer Andreas, Steinbrück Arnd, Jansson Volkmar, Dürr Hans Roland
Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.
Arch Med Sci. 2018 Aug;14(5):1087-1092. doi: 10.5114/aoms.2016.61939. Epub 2016 Aug 23.
Sexuality is an important factor in quality of life (QoL) and was reported to improve after total joint arthroplasty (TJA). However, one study group found evidence regarding a high rate of impaired erectile function of about 20% in male patients after TJA. As erectile dysfunction is a serious matter of concern and there are no data explaining this observation sufficiently, the purpose of this study was to revaluate the erectile function in patients after TJA.
All consecutive male patients scheduled for TJA were enrolled in this prospective study. Evaluation was performed pre- and 6 months postoperatively with the International Index of Erectile Function (IIEF-5) questionnaire. One hundred and fifty-nine patients fulfilled the inclusion criteria, and 51 patients wished not to take part in the study.
From the 108 patients who were included prior to surgery, 101 (94%) were available at the 6-month follow-up. In those patients, the preoperative erectile function was normal in 38 (24.0 ±1.1), impaired in 45 (14.7 ±6.5) and with no function in 18 patients. No significant difference in the pre- (15.4 ±9.3) and postoperative (15.3±9.2) IIEF-5 score was observed ( = 0.59) in the total group. Similarly, subgroup analysis revealed no significant difference in patients with total hip arthroplasty ( = 0.58), total knee arthroplasty ( = 0.37) or > 70 years ( = 0.08).
The previously reported high rate of impaired erectile function after TJA of the lower extremity could not be confirmed. Total joint arthroplasty remains a safe procedure in terms of postoperative erectile function.
性功能是生活质量（QoL）的一个重要因素，据报道全关节置换术（TJA）后性功能有所改善。然而，一个研究小组发现有证据表明，TJA术后男性患者勃起功能受损率高达20%左右。由于勃起功能障碍是一个严重的问题，且目前尚无数据充分解释这一现象，因此本研究的目的是重新评估TJA术后患者的勃起功能。
所有计划接受TJA的连续男性患者均纳入本前瞻性研究。术前及术后6个月采用国际勃起功能指数（IIEF-5）问卷进行评估。159例患者符合纳入标准，51例患者不愿参与本研究。
术前纳入的108例患者中，101例（94%）在6个月随访时仍可进行评估。在这些患者中，术前勃起功能正常者38例（24.0±1.1），受损者45例（14.7±6.5），无功能者18例。全组术前（15.4±9.3）和术后（15.3±9.2）IIEF-5评分无显著差异（P=0.59）。同样，亚组分析显示，全髋关节置换术患者（P=0.58）、全膝关节置换术患者（P=0.37）或年龄>70岁患者（P=0.08）之间也无显著差异。
先前报道的下肢TJA术后勃起功能受损率较高这一情况未能得到证实。就术后勃起功能而言，全关节置换术仍然是一种安全的手术。
