March 3, 2026

Testosterone Deficiency and Total Joint Replacement Outcomes: A Large Claims Database Study

Key Points

Testosterone deficiency is linked to higher risks of deep vein thrombosis and pulmonary embolism after total hip arthroplasty, impacting patient recovery.
In total knee arthroplasty patients, testosterone deficiency increases complications such as readmission and revision surgery within two years.
Analysis involved 133,696 males undergoing total hip arthroplasty, with 5,400 matched in testosterone deficiency and eugonadal cohorts for balance.
Findings highlight the importance of evaluating testosterone levels for improved management strategies in total joint arthroplasty patients.

Abstract

Testosterone deficiency (TD) affects a significant portion of the aging male population, leading to muscle loss and reduced bone density. Most men with TD do not receive testosterone replacement therapy (TRT). However, the association of untreated TD on surgical outcomes after total joint arthroplasty (TJA), including total hip (THA) and total knee arthroplasty (TKA) remains unexplored. This study aims to assess whether untreated TD influences surgical outcomes in TJA patients without prior TRT. This retrospective cohort study used data from the TriNetX US Research Network, a large claims database including over 95 healthcare organizations and 130 million patients. Male patients undergoing THA or TKA were divided into two groups based on testosterone levels (TD: < 3 00 ng/dL; eugonadal/non-TD: ≥300 ng/dL). Those with TRT before or within two years after TJA were excluded. Propensity score matching balanced demographics and comorbidities. Outcomes, including thromboembolic events, infections, prosthetic complications, revision, resection, readmission, and mortality, were assessed at 90 days, one year, and two years post-TJA. A total of 133,696 male patients without hormone replacement therapy who underwent THA were analyzed, with 5,400 patients in both testosterone deficiency (TD) and eugonadal cohorts after matching. TD patients had a higher risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) at ninety days, one year, and two years post-THA compared to their eugonadal counterparts. In the TKA population of 147,203 males, 6,658 patients per cohort were matched. TD patients had increased risk of DVT, aseptic loosening, manipulation, readmission, and revision surgery within two years but lower risk of prosthetic joint infection than eugonadal men. Testosterone deficiency influences postoperative outcomes in TJA, with distinct patterns observed in THA and TKA. These findings suggest that hypogonadal status should be considered in the perioperative management of patients undergoing TJA.

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Cite This Study

Glenn et al. (Wed,) studied this question.

synapsesocial.com/papers/69a75c84c6e9836116a2573e https://doi.org/https://doi.org/10.1302/1358-992x.2026.1.004

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