Preoperative Testosterone Replacement Therapy Is Associated With Increased Complication Risk After Total Hip Arthroplasty: A Propensity-Matched Analysis of Real-World Data.

BACKGROUND

While testosterone replacement therapy (TRT) is known to affect cardiovascular physiology, its impact on outcomes following total hip arthroplasty (THA) remains unclear. This study aimed to assess whether preoperative TRT use is associated with increased complications following THA.

METHODS

A retrospective cohort study using a large national database was performed. Adult patients undergoing primary THA before February 2020 with 5-year follow-up were stratified based on preoperative TRT use within one year of surgery. Patients who had a history of septic arthritis, osteonecrosis, or pathologic fractures were excluded. Propensity score matching (1:1) was used to balance cohorts. Outcomes included medical complications at 90 days and one year and prosthetic complications up to five years postoperatively. Following matching, 3,953 patients were included in each cohort.

RESULTS

At 90 days, TRT use was associated with higher rates of deep vein thrombosis (2.8 versus 2.0%; P = 0.023), pneumonia (3.2 versus 1.7%; P < 0.001), and sepsis (4.2 versus 0.9%; P < 0.001). At one year, TRT users had increased rates of deep vein thrombosis (4.3 versus 3.0%; P = 0.002), cardiac events (2.9 versus 1.7%; P < 0.001), pneumonia (6.1 versus 3.4%; P < 0.001), acute kidney injury (7.6 versus 5.6%; P < 0.001), and sepsis (3.8 versus 1.9%; P < 0.001). At five years, TRT users had higher rates of periprosthetic joint infection (3.1 versus 1.6%; P < 0.001), periprosthetic fracture (2.4 versus 1.4%; P = 0.003), loosening (1.7 versus 1.0%; P = 0.007), prosthetic dislocation (2.5 versus 1.2%; P < 0.001), and revision surgery (4.1 versus 2.3%; P < 0.001).

CONCLUSIONS

Preoperative TRT use was associated with increased risk of medical and prosthetic-related complications following THA.