A recent study presented at the 2026 AAOS Annual Meeting has revealed a significant link between testosterone therapy and increased postoperative risks following total knee replacement surgery. Patients using testosterone therapy faced higher rates of infection, blood clots, kidney damage, pneumonia, and knee instability. This article delves into the details of this research, exploring the potential risks and implications for individuals considering or undergoing knee replacement.
Introduction
Testosterone replacement therapy (TRT) has become increasingly popular among men experiencing low testosterone levels, often prescribed to alleviate symptoms like fatigue, reduced libido, and muscle loss. Simultaneously, total knee arthroplasty (TKA), or knee replacement surgery, remains a common and effective procedure for individuals suffering from severe osteoarthritis. With TKA procedures projected to exceed 1 million annually by 2030, understanding the potential interactions between TRT and postoperative outcomes is crucial. A recent large-scale study has uncovered a concerning link between testosterone therapy and increased risks following knee replacement surgery, highlighting the need for careful consideration and patient education.
Study Overview
The study, presented at the American Academy of Orthopaedic Surgeons (AAOS) 2026 Annual Meeting, analyzed data from 13,250 patients undergoing primary TKA. This landmark propensity-matched study, using a national EHR database, followed patients for up to five years to assess postoperative complications. The study balanced male and female cohorts to provide a comprehensive analysis of the effects of preoperative TRT use within 12 months of surgery. The findings revealed that patients on TRT faced significantly higher incidences of serious complications, including pulmonary embolism, pneumonia, acute kidney injury, sepsis, periprosthetic joint infection, instability, and revision surgery.
Study Methodology
- Patient Cohort: The study included 13,250 patients undergoing primary TKA, with a near-equal distribution of men and women.
- Data Source: A national EHR (Electronic Health Record) database was used to collect patient data.
- Follow-up Period: Patients were followed for up to five years post-surgery.
- Analysis: Propensity-matched analysis was conducted to compare outcomes between patients who used TRT preoperatively and those who did not.
Health Risks Associated with Testosterone Therapy
The study identified several significant postoperative risks associated with testosterone therapy in patients undergoing total knee replacement. These risks spanned from short-term complications within 90 days to long-term issues persisting up to five years after surgery.
Short-Term Risks (90 Days)
Within the first 90 days following TKA, patients on TRT exhibited significantly higher rates of several serious complications:
- Pulmonary Embolism (PE): TRT users had a 1.6% incidence rate compared to 1.2% in non-users (P=0.041).
- Pneumonia: The rate of pneumonia was 3.3% in TRT users versus 1.9% in non-users (P<0.001).
- Acute Kidney Injury (AKI): TRT users experienced a 4.2% rate of AKI, while non-users had a 2.9% rate (P<0.001).
- Sepsis: The incidence of sepsis was 1.9% in TRT users compared to 1.1% in non-users (P<0.001).
Intermediate-Term Risks (One Year)
At the one-year mark, the elevated risks associated with TRT persisted:
- Deep Vein Thrombosis (DVT): TRT users had a 4.5% rate of DVT compared to 3.3% in non-users.
- Cardiac Events: The incidence of cardiac events was 3% in TRT users versus 2.4% in non-users.
- Kidney Injury: TRT users experienced a 7.9% rate of kidney injury, while non-users had a 5.2% rate.
Long-Term Risks (Five Years)
Over the long term, up to five years post-surgery, TRT use was associated with increased risks of:
- Periprosthetic Joint Infection (PJI): TRT users had a higher rate of PJI (4.3% vs. baseline).
- Instability: Increased risk of knee instability.
- Implant Loosening: Higher incidence of implant loosening.
- Revision Surgery: Elevated rates of revision surgery.
Clinical Implications and Recommendations
Given these findings, the researchers emphasize the importance of disclosing TRT use prior to undergoing total knee replacement surgery. The increased risk of blood clots and potential interference with joint integration necessitates careful consideration and management.
Dr. Brian Chalmers, Senior Researcher, stated, "With more people taking this hormone than ever, and (knee replacement) surgeries expected to exceed 1 million per year by 2030, we wanted to dive deeper into the question of testosterone’s post-surgical effects."
The study suggests that surgeons should screen patients for TRT history and consider implementing discontinuation protocols before surgery. Testosterone's prothrombotic effects may impair healing and osseointegration, contributing to the observed complications.
Key recommendations include:
- Screening: Surgeons should routinely screen patients undergoing TKA for a history of TRT use.
- Patient Education: Patients should be informed about the potential risks associated with TRT and TKA.
- Discontinuation Protocols: Consider implementing protocols for discontinuing TRT prior to surgery, when appropriate.
- Risk Management: Implement strategies to mitigate the increased risks of blood clots, infection, and other complications in TRT users.
Conclusion
The study presented at the 2026 AAOS Annual Meeting provides compelling evidence of the increased risks associated with testosterone therapy in patients undergoing total knee replacement surgery. The findings highlight the importance of thorough preoperative screening, patient education, and careful management of TRT in individuals considering or undergoing TKA. By understanding and addressing these risks, healthcare providers can work to improve patient outcomes and ensure safer surgical experiences.
Key Takeaways
- Testosterone therapy is linked to increased postoperative risks in knee replacement surgery.
- Patients on TRT face higher rates of complications such as infections and blood clots.
- Surgeons should screen for TRT use and consider discontinuation protocols before surgery.
- Patient education is crucial to inform about potential risks associated with TRT.
FAQ
What is testosterone therapy?
Testosterone therapy is a medical treatment that aims to boost testosterone levels in men who have low levels of this hormone.
What are the risks of testosterone therapy during knee surgery?
Risks include increased rates of infection, blood clots, kidney damage, and complications leading to revision surgery.
How can patients prepare for knee surgery if they are on TRT?
Patients should inform their surgeons about their TRT use and discuss potential discontinuation before surgery.
