Related Experiment Video
Updated: Jun 9, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Outcomes of total hip arthroplasty in males undergoing testosterone replacement therapy: A propensity-matched
Carlo M Mannina1, Muhammad Hamza Ilyas1, Isaiah A Freeman1
1Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Background:
Testosterone replacement therapy (TRT) use has risen among older men, including those undergoing total hip arthroplasty (THA). While TRT may influence general musculoskeletal health and surgical outcomes, its relationship with postoperative outcomes following THA remains unclear. This study aimed to evaluate the potential association between preoperative TRT use and postoperative medical and surgical outcomes in male patients undergoing primary THA using a propensity-matched analysis.
Methods:
The TriNetX database was queried for male patients undergoing primary THA. Patients with TRT prescribed prior to THA were propensity-score matched 1:1 to non-users by age, body mass index, race, ethnicity, and various medical comorbidities. Outcomes included 90-day rates of readmission, surgical site infection, deep vein thrombosis, pulmonary embolism, and acute renal failure, as well as one- and two-year rates of periprosthetic joint infection (PJI), all-cause reoperation, mechanical complications, and revision THA. After propensity-matching, 1,344 TRT users and 1,344 non-users were identified.
Results:
Patients who received preoperative TRT had significantly higher rates of revision THA (4.2 versus 2.1%, P = 0.002), PJI (3.8 versus 2.2%, P = 0.018), all-cause reoperation (5.40 versus 2.92%, P = 0.001), and mechanical complication (6.20 versus 3.79%, P = 0.004) at two-year follow-up. Similar trends were seen in the one-year postoperative period. There was no difference between cohorts in the 90-day rates of readmission or all assessed medical complications.
Conclusion:
Preoperative TRT use in male patients prior to THA was associated with significantly increased incidence of revision THA, PJI, reoperation, and mechanical complications at one- and two-year follow-up. This study provides evidence-based information for preoperative counseling of male patients using or considering the use of testosterone supplementation prior to THA.
