Preoperative Testosterone Replacement Therapy Is Associated With Increased Complication Risk After Total Knee...

While testosterone replacement therapy (TRT) is known to affect cardiovascular physiology, its impact on outcomes following total knee arthroplasty (TKA) remains unclear. This study aimed to assess whether preoperative TRT use is associated with increased complications following TKA.

A retrospective cohort study using a large national database was performed. Patients undergoing primary TKA before February 2020 with 5-year follow-up were stratified based on preoperative TRT use within one year of surgery. Patients who had a history of septic arthritis, osteonecrosis, or pathologic fractures were excluded. Propensity score matching (1:1) was used to balance cohorts. Outcomes included medical complications at 90 days and one year postoperatively and periprosthetic complications up to five years postoperatively. After matching, 6,625 patients were included in each cohort.

At 90 days, TRT use was associated with higher rates of pulmonary embolism (odds ratio (OR) 1.4, 95% confidence interval (CI): 1.0 to 1.8, P = 0.041), pneumonia (OR 1.8, 95% CI: 1.4 to 2.3, P < 0.001), acute kidney injury (OR 1.5, 95% CI: 1.2 to 1.8, P < 0.001), and sepsis (OR 1.8, 95% CI: 1.3 to 2.4, P < 0.001). At one year, TRT patients had elevated deep vein thrombosis (OR 1.4, 95% CI: 1.1 to 1.6, P < 0.001), cardiac event (OR 1.3, 95% CI: 1.0 to 1.6, P = 0.018), and pneumonia (OR 1.6, 95% CI: 1.3 to 1.8, P < 0.001) rates. At five years, TRT use was associated with increased periprosthetic joint infections (OR 2.3, 95% CI: 1.8 to 2.8, P < 0.001), periprosthetic fractures (OR 2.7, 95% CI: 1.9 to 4.0, P < 0.001), and revision surgeries (OR 1.5, 95% CI: 1.2 to 1.8, P < 0.001).

Preoperative TRT use was associated with increased risk of complications following TKA.