Association of Testosterone Supplementation with the Risk of Infection following Primary Total Hip Arthroplasty

Reoperation due to infection remains a devastating complication of total hip arthroplasty (THA). Prescriptions for supplemental testosterone are also increasing yearly, which is relevant given the populations who undergo THA and those prescribed testosterone have significant overlap. This study aimed to evaluate supplemental testosterone as a risk factor for all cause reoperation and reoperation due to infection.

Utilizing the MarketScan Commercial Claims Database (Merative), we performed a retrospective matched cohort study. Out of 61,133 THA procedures in men, Mahalanobis nearest neighbor matching was utilized to achieve a final population for analysis consisting of 1,956 patients prescribed testosterone and the 19,560 patients not prescribed testosterone. Data analyses included univariate and multivariate regression. There were no significant demographic differences between the groups.

Prescription testosterone within 1 year of THA was a significant predictor of all cause reoperation (OR=1.6, CI=1.2-2.2, P=0.001) and reoperation due to infection (OR=1.8, CI=1.1-2.7, P=0.01). Men prescribed testosterone were at higher cumulative incidence for both all cause reoperation and reoperation due to infection at years 1 to 5 (P<0.05 for all years). There were more prescriptions for testosterone in the south (P<0.001). Younger age (OR=1.0, CI=0.9-1.0, P=0.01) and diabetes mellitus diagnoses were risk factors for reoperation due to infection (OR=1.6, CI=1.0-2.4, P=0.03).

Men prescribed testosterone within 1 year prior to THA were more likely to undergo all-cause reoperation and reoperation due to infection. Arthroplasty surgeons should that younger patients have a higher rate of reoperation due to infection as well.