Risk of complications after total hip arthroplasty in patients on testosterone replacement therapy

BACKGROUND: Testosterone replacement therapy (TRT) may cause side effects after orthopedic procedures. With total hip arthroplasty (THA) rates increasing, this study evaluates the relationship between TRT and postoperative complications in THA patients. METHODS: A retrospective review in a large academic hospital was conducted of hypogonadal patients treated with TRT, who underwent primary, elective THA between 2012 and 2024. These were 1:2 propensity-matched based on age, body-mass index, and comorbidities to a "control" group that was not treated with TRT. Patient and TRT characteristics including serum testosterone levels, form of administration, 90-day emergency department visits (ED) and readmissions, reoperations and revisions were explored. RESULTS: Among 152 patients aged 61.3 years who underwent THA with a 2.7-year follow-up, TRT was mainly administered intramuscularly (51.3%) or via transdermal gel (46.1%), followed by pellets (2.0%), and oral tablets (1.6%). Overall rates of 90-day ED visits and readmissions did not differ significantly between TRT and control patients (7.9% vs. 5.3%, P = 0.270 and 7.9% vs. 5.6%, P = 0.225, respectively). TRT patients had a significantly lower rate of 90-day ED visits due to surgery-related causes (0.7% vs. 2.3%, P = 0.048) but a significantly higher rate due to non-surgery-related causes (7.2% vs. 3.0%, P = 0.034). The incidence of PJI did not differ significantly between the groups (2.0% vs. 1.0%, P = 0.319). Reoperations and revisions were not different between the groups (P = 0.650 and P = 0.057, respectively). TRT administration form was not associated with 90-day ED visits (P = 0.380), readmissions (P = 0.563), reoperations (P = 0.441) or revisions (P = 0.669). Testosterone levels demonstrated a weak, negative, yet significant correlation with 90-day ED visits (r = -0.35, P = 0.040), but not with reoperations or revisions (P = 0.348 and P = 0.431, respectively). CONCLUSIONS: TRT in THA patients was associated with a reduced rate of surgery-related 90-day ED visits but an increased rate of non-surgery-related 90-day ED visits. Incidence of PJI and overall 90-day ED visits and readmission rates did not significantly differ. Administration form had no significant impact, while higher testosterone levels were linked to fewer 90-day ED visits. Although limited by its retrospective design and patient exclusions, further investigation is warranted to guide perioperative management in these patients, particularly given the known immunomodulatory effects of exogenous TRT.