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Risks of Testosterone Replacement Therapy after Total Knee Arthroplasty

Recent research presented at the 2026 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) suggests a troubling correlation between testosterone replacement therapy (TRT) and adverse health outcomes in patients undergoing total knee arthroplasty (TKA).

Rising Testosterone Therapy Prescriptions

Testosterone therapy has become increasingly prevalent, with prescriptions surging from approximately 7.3 million in 2019 to over 11 million in 2024. This trend raises concern, particularly as more studies uncover potential health risks associated with testosterone use, especially around surgical procedures.

Study Overview

The groundbreaking study led by twin medical students, Argen and Arsen Omurzakov, reviewed outcomes of more than 13,000 individuals who underwent knee replacement surgery. Their research stands out as one of the largest studies covering both male and female populations equally, focusing on those who had taken testosterone supplements in the year prior to surgery.

Key Findings

The findings were alarming. Patients who had used testosterone were found to face significantly higher postoperative risks, including infections, blood clots, pneumonia, and renal complications. Key data highlighted in the study include:

• - At 90 Days Post-Surgery: Patients on TRT experienced higher rates of pulmonary embolism (1.6% vs. 1.2%), pneumonia (3.3% vs. 1.9%), acute kidney injury (4.2% vs. 2.9%), and sepsis (1.9% vs. 1.1%).
• - At One Year Post-Surgery: TRT users had elevated rates of pulmonary embolism (2.6% vs. 2.0%), deep vein thrombosis (4.5% vs. 3.3%), as well as other significant complications.

Even five years following the surgery, the risks remained pronounced, with rates of periprosthetic joint infection soaring among TRT users, emphasizing the long-term repercussions of testosterone therapy.

Exploring the Mechanism

The connection between TRT and increased complications is an area of ongoing inquiry. The Omurzakovs speculate that testosterone impacts the body’s natural healing processes, regulating not only bone growth but potentially influencing the immune response and recovery mechanisms in patients undergoing surgery.

The Implications of Study Findings

As the number of knee replacement surgeries continues to rise, projected to exceed one million annually by 2030, understanding the effects of treatments like testosterone becomes critical. With the current demographic shift witnessing a significant proportion of TKA patients being women, the implications of this research grow exponentially.

Call to Action for Further Research

While some aspects of this study require further validation, it raises an urgent need for more comprehensive investigations into the long-term effects of TRT, especially within surgical contexts. The high complication rates elucidated in this research should compel practitioners to reassess the risks versus benefits of prescribing TRT, particularly for patients awaiting surgical interventions.

In conclusion, with the dramatic rise of testosterone therapy and the prevalence of knee replacements, medical professionals must prioritize patient safety and consider these findings when advising treatments that involve testosterone. Future clinical practices may be shaped by the necessity of understanding hormonal impacts on surgical recovery and overall patient health.