Preoperative testosterone replacement therapy is associated with increased rates of periprosthetic joint infection, acute kidney injury, and emergency department utilization after total shoulder arthroplasty: a propensity-score matched analysis.

TRT patients had significantly higher rates of emergency department visits at 90 days postoperatively following TSA.

• 90-day ED visit rate was 13.7% in TRT patients vs. 8.1% in non-TRT patients
• Risk ratio of 1.69 (P < .001)
• Analysis based on propensity-score matched cohorts of 1,369 patients each
• Matching was performed in a 1:1 ratio to balance demographic variables and comorbidities

TRT patients demonstrated increased rates of emergency department utilization at 1 year after TSA.

• 1-year ED utilization rate was 26.6% in TRT patients vs. 16.9% in controls
• Risk ratio of 1.58 (P < .001)
• The TriNetX database was queried to identify patients undergoing TSA before 2020
• TRT was defined as use within 1 year before surgery

TRT patients had significantly higher rates of acute kidney injury at 1 year following TSA.

• 1-year acute kidney injury rate was 17.5% in TRT patients vs. 12.1% in controls
• Risk ratio of 1.45 (P < .001)
• This finding was identified in propensity-score matched cohorts with no detected baseline differences

TRT was associated with doubled rates of periprosthetic joint infection at 1 year after TSA.

• 1-year PJI rate was 4.8% in TRT patients vs. 2.4% in controls
• Risk ratio of 2.00 (P < .001)
• This represents a twofold increase in PJI risk associated with preoperative TRT use

TRT was associated with increased rates of periprosthetic joint infection at 5 years following TSA.

• 5-year PJI rate was 7.9% in TRT patients vs. 4.5% in controls
• Risk ratio of 1.74 (P < .001)
• The elevated PJI risk persisted over the long-term follow-up period of 5 years

Propensity score matching successfully balanced baseline demographic variables and comorbidities between TRT and non-TRT cohorts.

• Matching was performed in a 1:1 ratio using the TriNetX database analytics platform
• Following propensity score matching, 1,369 patients were included in each cohort
• No baseline differences were detected after matching
• Patients were stratified based on preoperative TRT use within 1 year before surgery