Clinically Symptomatic Low Serum Testosterone Significantly Increases the Risk of Complications in Rural Male Patients Undergoing Total Hip Arthroplasty: A Propensity Matched Cohort Study

Background: As the prevalence of hypogonadism increases with age, there is a greater chance that patients with hypogonadism will undergo arthroplasty. Hypogonadism has been associated with sarcopenia and overall low musculoskeletal health. There is a paucity of investigations on the effect of symptomatic hypogonadism on total hip arthroplasty (THA) outcomes. The aim of this study was to determine the relationship between symptomatic hypogonadism and complication rates, hospital length of stay, and discharge disposition for rural patients undergoing THA. Methods: A retrospective review was performed from 2013 to 2023 identifying a consecutive cohort of primary THA patients with low serum testosterone using relevant data from the International Classification of Diseases, Tenth Revision. Diagnoses were confirmed via manual chart review. Patients were matched at a 1:4 ratio based on demographic data. Primary outcomes compared all-cause 90-day complications following THA in patients with normal versus low serum testosterone levels. Results: This study included 325 patients (65 with low serum testosterone and 260 with normal serum testosterone). The low serum testosterone cohort had a significantly higher rate of developing complications at 90 days after THA (12.3% vs 5%, P = 0.03). There were no differences in the rate of discharge to a skilled nursing facility (10.8% vs 12.7%, P = 0.67) or average length of stay (1.8% vs 1.9%, P = 0.65) between the cohorts. A logistic regression analysis revealed that patients with low serum testosterone levels had a 6.27-fold increased odds ( P < 0.01) of developing a complication. Patients who were married and/or living with a partner had a decreased risk of complications within 90 days (odds ratio = 0.41, P < 0.01). Conclusions: Low preoperative serum testosterone is associated with a significantly increased risk of surgical complications following THA with no effect on length of stay or discharge disposition. Being married or living with a partner may lower this risk. These findings can help surgeons manage post-operative expectations and guide patient education and discussion.