Testosterone Therapy & Knee Replacement: Increased Risks?

The increasing popularity of testosterone therapy in the United States may carry unforeseen risks for individuals undergoing total knee replacement surgery, according to research presented this week at a meeting of the American Academy of Orthopaedic Surgeons in Fresh Orleans. The study suggests a potential link between testosterone use and a higher incidence of post-surgical complications, prompting a closer look at hormone therapy protocols for patients preparing for or recovering from joint replacement.

Testosterone Use on the Rise

Prescriptions for testosterone replacement have climbed significantly in recent years, jumping from 7.3 million in 2019 to over 11 million in 2024. Both men and women are increasingly seeking testosterone therapy to combat the effects of aging, build muscle and bone density, and improve libido. While the hormone is often associated with benefits, this new research highlights a potential downside for a growing segment of the population: those needing knee replacement surgery. The number of knee replacements is as well expected to rise, exceeding 1 million procedures annually by 2030, making this a critical area for investigation.

Study Findings: Increased Complication Rates

Researchers tracked over 13,000 patients who received total knee replacements, comparing outcomes for those on testosterone therapy with those who were not. The data revealed a statistically significant increase in several complications within 90 days of surgery for patients taking testosterone. These included a higher rate of blood clots in the lungs (1.6% versus 1.2%), pneumonia (3.3% versus 1.9%), kidney injury (4.2% versus 2.9%), and sepsis (1.9% versus 1.1%). These elevated risks persisted one year after surgery, with continued higher rates of blood clots, deep vein thrombosis, cardiac events, pneumonia, and kidney injury among those who had been on testosterone therapy. Powers Health reports these findings.

Understanding the Complications

Several of the complications identified in the study require further explanation. Sepsis, for example, is a life-threatening condition that arises when the body’s response to an infection spirals out of control, leading to tissue damage, organ failure, and potentially death. HealthDay provides a clear overview of the study’s implications. Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, usually in the leg. If the clot breaks loose and travels to the lungs, it can cause a pulmonary embolism, a potentially fatal condition. Kidney injury can range from mild impairment to acute kidney failure, requiring dialysis or long-term management.

What Does This Mean for Patients?

It’s crucial to understand that this study demonstrates an association, not necessarily a direct causation. While the data suggest a link between testosterone therapy and increased post-surgical risks, it doesn’t definitively prove that testosterone causes these complications. Other factors, such as underlying health conditions, age, and lifestyle choices, could also play a role. The researchers emphasize the need for further investigation to fully understand the mechanisms behind this observed relationship.

Patients currently undergoing or considering testosterone therapy who are scheduled for knee replacement surgery should discuss these findings with their orthopedic surgeon and endocrinologist. It’s significant to have a comprehensive evaluation of individual risk factors and to weigh the potential benefits of testosterone therapy against the potential risks in the context of upcoming surgery. Medical Xpress also covered the study, highlighting the importance of patient awareness.

Limitations and Further Research

The study, while significant, has limitations. It’s observational in nature, meaning researchers observed existing patterns rather than controlling variables in a randomized controlled trial. This makes it difficult to definitively establish cause and effect. The study relied on patient records to determine testosterone use, which may be subject to inaccuracies or incomplete information. Future research should focus on conducting prospective, randomized controlled trials to confirm these findings and to identify the specific mechanisms by which testosterone therapy might increase post-surgical risks. Investigating the optimal timing of testosterone therapy cessation before and after surgery could also be beneficial.

The Role of Public Health Surveillance

The findings underscore the importance of ongoing surveillance of post-surgical complications in patients receiving hormone therapy. Healthcare systems should consider incorporating testosterone use into their data collection and analysis protocols to identify potential trends and to monitor the impact of any changes in clinical practice. This type of surveillance can support to ensure that patients receive the best possible care and that potential risks are identified and mitigated promptly.

What comes next: The Hospital for Special Surgery in New York City, where the lead researcher Dr. Brian Chalmers is based, plans to conduct further studies to explore the underlying biological mechanisms linking testosterone therapy to increased surgical risks. These studies will aim to identify specific patient populations who may be at higher risk and to develop strategies for minimizing complications. Orthopedic surgeons and endocrinologists are encouraged to stay informed about emerging research in this area and to incorporate the latest evidence into their clinical decision-making.