Testosterone Replacement Therapy Is Not Associated with Greater Revision Rates in Reverse Total Shoulder Arthroplasty

Area of Science:

• Orthopedic Surgery
• Endocrinology
• Patient Safety

Background:

• Testosterone replacement therapy (TRT) use is rising for hypogonadism and gender-affirming care.
• The impact of TRT on orthopedic surgery outcomes remains unclear.
• Investigating TRT's effect on reverse total shoulder arthroplasty (RSA) is crucial.

Purpose of the Study:

• To evaluate the association between TRT and outcomes following RSA.
• To compare revision rates, periprosthetic joint infection (PJI), and fracture rates in RSA patients with and without recent TRT use.

Main Methods:

• Retrospective cohort study of RSA patients (2010-2022) using the PearlDiver database.
• Patients receiving TRT within 90 days of RSA were matched to a control group based on Charlson Comorbidity Index, age, and gender.
• Univariate analyses (chi-squared, t-tests) compared outcomes between groups.

Main Results:

• 1906 patients in the TRT group were matched with 1906 controls.
• No significant difference in revision RSA rates (12.01% vs. 11.02%, p=0.335).
• Similar rates of PJI (1.42% vs. 1.63%, p=0.597) and periprosthetic fractures (0.58% vs. 1.05%, p=0.105) between groups.

Conclusions:

• TRT use within 90 days of RSA is not associated with increased rates of revision, PJI, or fracture.
• Surgeons can confidently evaluate patients on TRT considered for RSA.
• This study provides evidence for managing TRT in patients undergoing shoulder arthroplasty.