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This retrospective cohort study investigated the impact of preoperative testosterone replacement therapy (TRT) on complications following primary total hip arthroplasty (THA). Using a national database, 3,953 patients undergoing THA with and without preoperative TRT were propensity-matched and followed for up to five years. The study found that preoperative TRT use was associated with increased risks of DVT, pneumonia, sepsis, cardiac events, acute kidney injury, periprosthetic joint infection, periprosthetic fracture, loosening, dislocation, and revision surgery.
Preoperative testosterone replacement therapy is associated with a significantly increased risk of both medical and prosthetic complications following total hip arthroplasty.
BACKGROUND While testosterone replacement therapy (TRT) is known to affect cardiovascular physiology, its impact on outcomes following total hip arthroplasty (THA) remains unclear. This study aimed to assess whether preoperative TRT use is associated with increased complications following THA. METHODS A retrospective cohort study using a large national database was performed. Adult patients undergoing primary THA before February 2020 with five-year follow-up were stratified based on preoperative TRT use within one year of surgery. Patients who had a history of septic arthritis, osteonecrosis, or pathologic fractures were excluded. Propensity score matching (1:1) was used to balance cohorts. Outcomes included medical complications at 90 days and one year and prosthetic complications up to five years postoperatively. Following matching, 3,953 patients were included in each cohort. RESULTS At 90 days, TRT use was associated with higher rates of deep vein thrombosis (2.8 versus 2.0%, P = 0.023), pneumonia (3.2 versus 1.7%, P < 0.001), and sepsis (4.2 versus 0.9%, P < 0.001). At one year, TRT users had increased rates of deep vein thrombosis (4.3 versus 3.0%, P = 0.002), cardiac events (2.9 versus 1.7%, P < 0.001), pneumonia (6.1 versus 3.4%, P < 0.001), acute kidney injury (7.6 versus 5.6%, P < 0.001), and sepsis (3.8 versus 1.9%, P < 0.001). At five years, TRT users had higher rates of periprosthetic joint infection (3.1 versus 1.6%, P < 0.001), periprosthetic fracture (2.4 versus 1.4%, P = 0.003), loosening (1.7 versus 1.0%, P = 0.007), prosthetic dislocation (2.5 versus 1.2%, P < 0.001), and revision surgery (4.1 versus 2.3%, P < 0.001). CONCLUSION Preoperative TRT use was associated with increased risk of medical and prosthetic-related complications following THA.
