TRT in THA patients was associated with a reduced rate of surgery-related 90-day ED visits but an increased rate of non-surgery-related 90-day ED visits, while overall complication rates including PJI, readmissions, reoperations, and revisions did not significantly differ from controls.
Overall 90-day emergency department visit and readmission rates did not differ significantly between TRT and control patients after total hip arthroplasty.
TRT patients had a significantly lower rate of 90-day ED visits due to surgery-related causes compared to controls.
TRT patients had a significantly higher rate of 90-day ED visits due to non-surgery-related causes compared to controls.
The incidence of periprosthetic joint infection (PJI) did not differ significantly between TRT and control groups.
Reoperation and revision rates were not significantly different between TRT and control groups.
The form of TRT administration was not associated with any measured postoperative complication outcome.
Higher serum testosterone levels demonstrated a weak but significant negative correlation with 90-day ED visits, but not with reoperations or revisions.
This research examined whether men taking testosterone replacement therapy (TRT) — a treatment for low testosterone levels — face different risks of complications after total hip replacement surgery compared to similar men not on TRT. The study followed 152 patients over an average of about 2.7 years and matched TRT users to non-users based on age, weight, and health conditions to make the comparison as fair as possible. Overall, the two groups had similar rates of emergency room visits, hospital readmissions, infections around the implant, and need for additional surgeries. However, when researchers looked more closely at the reasons for emergency room visits within 90 days of surgery, they found an interesting split: TRT patients were less likely to visit the ER for surgery-related problems (0.7% vs. 2.3%) but more likely to visit for non-surgery-related problems (7.2% vs. 3.0%). Additionally, men with higher testosterone levels in their blood tended to have fewer emergency room visits overall. The type of TRT delivery — whether injections, skin gels, pellets, or tablets — did not appear to matter for any of the outcomes studied. This research suggests that TRT does not appear to significantly increase the overall risk of major complications after hip replacement surgery, but it may shift the nature of postoperative health events. The authors note that testosterone is known to affect the immune system, which could explain some of these patterns. Because this was a retrospective study at a single academic hospital with a relatively small sample, the authors call for larger studies to better understand how TRT should be managed around the time of surgery.
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Upload Your LabsKhury F, Antonioli S, Ruff G, Sarfraz A, Grossman E, Rozell J, et al.. (2026). Risk of complications after total hip arthroplasty in patients on testosterone replacement therapy.. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. https://doi.org/10.1007/s00590-026-04774-2