Effect of Supplemental Testosterone Use on Shoulder Arthroplasty Infection Rates

Supplemental testosterone use among patients undergoing shoulder arthroplasty can increase the Cutibacterium acnes load on the skin. Although higher C. acnes loads on the skin are associated with higher amounts of bacteria in deep tissues, it is unknown whether preoperative testosterone use increases the risk of shoulder prosthetic joint infection. Therefore, the purpose of this study was to determine if there is a temporal relationship between testosterone use and the risk of prosthetic joint infection after shoulder arthroplasty.

The PearlDiver database was queried to identify a cohort of patients who underwent shoulder arthroplasty (hemiarthroplasty, anatomic or reverse total shoulder arthroplasty) with minimum 2-year follow-up. Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes were used to compare the demographics and comorbidities of patients with (n = 2,285) and without testosterone use (n = 41,712). Patients with testosterone use were further stratified by the duration between last testosterone use and surgery. Prosthetic joint infection rates were compared between those with and without testosterone use.

The overall prevalence of testosterone use was 3.4%. Patients who used testosterone within 6-months prior to shoulder arthroplasty had a significantly higher rate of prosthetic joint infection at 3.4% compared to those without use at 2.4% [odds ratio (OR) = 1.44 (95% confidence interval (CI): 1.03 - 2.01, p = 0.042]. However, patients who used testosterone between 6- and 12-months before surgery did not have a significantly higher rate of infection. On multivariate analysis, only younger age [OR = 0.98 (95% CI: 0.97 - 0.99), p < 0.001] and diabetes [OR = 1.26 (95% CI: 1.10 - 1.44), p < 0.001] were independent risk factors for development of an infection.

Testosterone use within 6-months of shoulder arthroplasty may be associated with higher rates of prosthesis joint infection. However, patients who were taking testosterone but stopped before surgery did not have a higher rate of infection compared to those who never used the medication. Surgeons should actively screen patients for testosterone use. A referral to the patient's endocrinologist to discuss the risks and benefits of testosterone cessation prior to shoulder arthroplasty may also be warranted.

Level III; Retrospective Cohort Study using Large Database.