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Testosterone Deficiency and Total Joint Arthroplasty Outcomes-A Large Claims Database Study.

Eve R Glenn¹, Aurora J Grutman, Alexander R Zhu

¹From the Department of Orthopaedics, The Johns Hopkins University School of Medicine (Glenn, Zhu, O'Connell, Mousavi, Zhao, and Thakkar) and The Bloomberg School of Public Health, The Johns Hopkins University School of Medicine, Baltimore, MD (Grutman).

The Journal of the American Academy of Orthopaedic Surgeons

|September 22, 2025

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Testosterone deficiency (TD) is linked to worse outcomes after joint replacement surgery. Untreated TD increases risks for blood clots and complications in hip and knee arthroplasty patients.

Area of Science:

Orthopedics
Endocrinology
Surgical Outcomes Research

Background:

Testosterone deficiency (TD) impacts aging men, causing muscle loss and reduced bone density.
Most men with TD do not receive testosterone replacement therapy (TRT).
The effect of untreated TD on surgical outcomes after total joint arthroplasty (TJA) is unknown.

Purpose of the Study:

To investigate the association between untreated TD and surgical outcomes in TJA patients.
To compare outcomes in patients with TD versus eugonadal patients undergoing TJA without prior TRT.

Main Methods:

Retrospective cohort study using the TriNetX US Research Network (over 130 million patients).
Male patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) were grouped by testosterone levels (TD: <300 ng/dL; eugonadal: ≥300 ng/dL).

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Patients on TRT before or within 2 years post-TJA were excluded; propensity score matching balanced cohorts. Outcomes assessed up to 2 years post-TJA.

Main Results:

In THA (133,696 patients), TD was associated with higher risks of deep vein thrombosis and pulmonary embolism.
In TKA (147,203 patients), TD patients showed increased risks of deep vein thrombosis, aseptic loosening, manipulation, readmission, and revision surgery.
TD patients had a lower risk of prosthetic joint infection after TKA compared to eugonadal men.

Conclusions:

Untreated testosterone deficiency is linked to poorer postoperative outcomes in total joint arthroplasty.
Distinct outcome patterns were observed for total hip arthroplasty and total knee arthroplasty.
Hypogonadal status warrants consideration in the perioperative management of TJA patients.