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Testosterone Replacement Therapy Formulation and Potential Association With Risk of Revision Total Knee Arthroplasty
Maximillian P Ganz1, Randy M Cohn2, Giles R Scuderi2
1Northwell Health, Huntington Hospital, Huntington, New York; Northwell Health, Valley Stream Hospital, Valley Stream, New York.
Background:
Testosterone replacement therapy (TRT) is a commonly utilized treatment for male hypogonadism. Prescriptions for TRT are available in various formulations, including creams, gels, solutions, patches, intramuscular injections, and subcutaneous pellet implantation. Prior work identified the correlation between TRT and revision rotator cuff and quadriceps tendon rupture repair. The risk associated with TRT and total knee arthroplasty (TKA) is not currently delineated. This investigation sought to identify the relationship between TRT and revision TKA.
Methods:
Retrospective cohort analysis was conducted at a multihospital health system. Chart review of patients with hypogonadism and TKA was performed. Inclusion criteria included men aged 18 to 89 years, TRT prescription, and follow-up of at least 90 days. Analysis included TRT formulation, serum testosterone level, comorbidities, and analysis of TKA revision (septic versus aseptic revision). Statistical Package for Social Sciences was utilized to identify the significance of findings, P < 0.05.
Results:
Within the final cohort of 62 patients, 33 (53.2%) utilized topical TRT, 27 (43.55%) utilized injectable IM TRT, and two (3.2%) underwent implantation of a TRT pellet. There were six (9.7%) TKA revisions: three (4.8%) were for periprosthetic joint infection and three (4.8%) due to loosening without infection. Of revisions, five were in the IM TRT group and 1 in the topical TRT group. Average testosterone serum was higher for patients who had IM TRT (652.6 ng/dL) than topical TRT (356.1 ng/dL) (P = 0.001). Chi-square analysis determined increased likelihood of revision in the IM group compared to topical TRT group [Chi-square (1, N = 60) = 3.96, P = 0.046].
Conclusions:
This study suggests increased likelihood of TKA revision in patients undergoing TRT with IM formulation compared to topical TRT formulations. Modification of the TRT formulation in the perioperative TKA patient may provide a reduction in a modifiable risk for revision TKA secondary to infection.
