Does Testosterone Replacement Therapy Increase Risk of Thrombosis After Total Hip or Knee Arthroplasty?

Testosterone is a prothrombotic hormone, but the effect of exogenous testosterone on venous thromboembolic events (VTEs) following total joint arthroplasty (TJA) remains unclear. This study investigated the association between testosterone replacement therapy (TRT) and postoperative risk of VTE following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

We conducted a retrospective, matched cohort study using a national registry to identify primary THA or primary TKA patients from the years 2005 to 2025. Patients were stratified by TRT within three months of the TJA. There were 640,219 patients who had a THA (265,477) or a TKA (374,742) that were included. There were 1,469 THA (0.6%) and 2,032 (0.5%) TKA patients who were prescribed testosterone within three months before or after their TJA. A matched cohort was created after balancing demographics and comorbidities. Primary outcomes were DVT or pulmonary embolism (PE) within three months after their TJA. Measures of association models were used to calculate odds ratios (ORs).

We found a statistically significant increase in the rate of PE in TKA patients on TRT compared to those who were not (OR = 1.45; 95% confidence interval (CI), 1.04 to 2.02; P = 0.029). Rates of DVT in TKA patients on TRT were similar to those not on TRT (OR = 1.27; 95% CI, 0.98 to 1.65; P = 0.073). Similarly, there were no statistically significant differences in rates of PE (OR = 1.35; 95% CI, 0.88 to 2.05; P = 0.166) or DVT (OR = 1.26; 95% CI, 0.89 to 1.77; P = 0.192) between THA patients regarding TRT.

TRT was associated with a statistically significant increased rate of PE following TKA but not for DVT. Similarly, no significant difference was observed between TRT and VTE following THA. As the overlap between arthroplasty patients and patients on TRT increases, orthopaedic surgeons should be aware of the risks associated with TRT.