Related Experiment Video
Updated: Jan 11, 2026
09:01
Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
12.2K
Testosterone Replacement Therapy Is Associated with Extensor Mechanism Disruption after Total Knee Arthroplasty
José L Ayala-Ortiz1, Sean Taylor1, Hassan Ghomrawi1
1Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States.
The Journal of Knee Surgery
|November 12, 2025
Summary
Testosterone replacement therapy (TRT) significantly increases the risk of knee extensor mechanism disruption (EMD) after total knee arthroplasty (TKA). Patients on TRT were more than twice as likely to experience EMD, highlighting a critical risk factor for surgical outcomes.
Area of Science:
- Orthopedic Surgery
- Endocrinology
- Health Outcomes Research
Background:
- Testosterone replacement therapy (TRT) use has risen, with prior links to tendon ruptures.
- Knee extensor mechanism disruption (EMD) post-total knee arthroplasty (TKA) causes significant patient morbidity.
- The association between TRT and EMD after TKA is not well-established.
Purpose of the Study:
- To investigate the association between preoperative TRT and the risk of EMD in patients undergoing primary TKA.
- To identify TRT as a potential risk factor for EMD following TKA.
- To inform clinical practice regarding TRT use in TKA patients.
Main Methods:
- Retrospective cohort study using the Merative MarketScan database (2015-2022).
- Included adults (≥18 years) undergoing primary TKA with ≥3 years follow-up.
- EMD defined by ICD-10 codes; TRT defined by ≥3 months of prescription use pre-surgery.
- Multivariable logistic regression analyzed TRT's independent risk for EMD.
Main Results:
- Preoperative TRT was associated with a >2x increased likelihood of EMD (OR: 2.38, 95% CI: 1.39-4.09, p=0.002).
- This association was significant in males (OR: 3.00) but not females (OR: 1.10).
- Other risk factors included smoking, fluoroquinolone use, and female sex.
Conclusions:
- Preoperative TRT is a significant independent risk factor for knee EMD after TKA.
- Clinicians should consider TRT use when assessing TKA patient risk.
- Counseling patients on potential postoperative risks associated with TRT is crucial.
