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

Testosterone deficiency (TD) affects a notable portion of the aging male population, leading to muscle loss and reduced bone density. Most men with TD do not receive testosterone replacement therapy (TRT). However, the association of untreated TD on surgical outcomes after total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA), remains unexplored. This study aims to assess whether untreated TD is associated with poorer surgical outcomes in TJA patients without prior TRT.

This retrospective cohort study used data from the TriNetX US Research Network, a large claims database including over 95 healthcare organizations and 130 million patients. Male patients undergoing THA or TKA were divided into two groups based on testosterone levels (TD: <300 ng/dL; eugonadal/non-TD: ≥300 ng/dL). Those with TRT before or within 2 years after TJA were excluded. Propensity score matching balanced demographics and comorbidities. Outcomes, including thromboembolic events, infections, prosthetic complications, revision, resection, readmission, and mortality, were assessed at 90 days, 1, and 2 years post-TJA.

A total of 133,696 male patients without hormone replacement therapy who underwent THA were analyzed, with 5,400 patients in both TD and eugonadal cohorts after matching. TD patients had a higher risk of deep vein thrombosis and pulmonary embolism at 90 days, 1, and 2 years post-THA compared with their eugonadal counterparts. In the TKA population of 147,203 male patients, 6,658 patients per cohort were matched. TD patients had an increased risk of deep vein thrombosis, aseptic loosening, manipulation, readmission, and revision surgery within two years but lower risk of prosthetic joint infection than eugonadal men.

TD is associated with poorer postoperative outcomes in TJA, with distinct patterns observed in THA and TKA. These findings suggest that hypogonadal status should be considered in the perioperative management of patients undergoing TJA.