Testosterone Replacement Therapy in Orthopaedic Surgery.

TRT use has increased in prevalence due to increasing population age, medical benefits, and public awareness.

• Indicated treatments include late-onset hypogonadism, congenital syndromes, and gender affirmation hormonal therapy.
• The review identifies this increased prevalence as the motivating context for examining TRT's relationship to orthopaedic surgery outcomes.
• The paper frames TRT as 'not without concern for adverse risks' alongside its benefits.

TRT is associated with venous thromboembolic complications, cardiovascular events, and prostate issues as adverse risks.

• These risks are identified as primary safety concerns with TRT use.
• The review specifically flags these adverse risks as relevant considerations for orthopaedic surgical patients.
• The authors suggest future investigations should help 'mitigate adverse risks while optimizing benefits of TRT in the orthopaedic patient.'

TRT has a relationship with the development of osteoarthritis and incidence of total joint arthroplasty.

• The review identifies emerging research delineating the relationship between TRT and osteoarthritis development.
• TRT use is associated with differences in total joint arthroplasty incidence.
• The paper characterizes this relationship as 'complex.'

TRT is associated with musculotendinous pathology in orthopaedic patients.

• The review discusses TRT's relationship to musculotendinous conditions as a distinct area of orthopaedic concern.
• This is listed as a separate domain of TRT's orthopaedic effects alongside joint and bone findings.
• Specific pathologies are discussed in the context of TRT use.

TRT is associated with increased postoperative infection risk in orthopaedic surgery.

• Postoperative infection risk is identified as a specific adverse surgical outcome associated with TRT.
• This finding is presented as a safety concern relevant to surgical decision-making.
• The authors include this among the key TRT-related risks that surgeons should consider.

TRT is associated with improvements in postoperative rehabilitation metrics following orthopaedic surgery.

• Improved postoperative rehabilitation metrics are listed as a potential benefit of TRT in orthopaedic surgical patients.
• This is identified as one of the beneficial effects that surgeons could potentially optimize.
• The finding is presented alongside other beneficial outcomes including osseous healing and bone-implant integration.

TRT is associated with enhancement of osseous healing and increased bone-implant integration.

• Enhanced osseous healing is identified as a potential benefit of TRT relevant to orthopaedic surgery.
• Increased bone-implant integration is listed as a distinct TRT-associated benefit in surgical contexts.
• These beneficial effects are framed as outcomes that surgeons may be able to optimize through appropriate TRT management.

The authors identify multiple future areas of investigation needed to guide TRT management in orthopaedic patients.

• Future research directions are proposed to help surgeons 'mitigate adverse risks while optimizing benefits of TRT in the orthopaedic patient.'
• The paper frames current research as 'beginning to delineate the complex relationship between TRT' and orthopaedic outcomes, suggesting the evidence base is still developing.
• Guidance on perioperative TRT management is identified as an area requiring further study.