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

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).
• 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.