Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Testosterone replacement therapy (TRT) has previously been associated with adverse outcomes after orthopedic surgery. However, the association of preoperative, exogenous TRT use and postoperative outcomes of total ankle arthroplasty (TAA) has not yet been explored. In this study we aim to elucidate the relationship between exogenous TRT use and postoperative outcomes in patients undergoing TAA.
Methods:
A retrospective cohort study was conducted using a large administrative claims database. Patients who underwent TAA and used preoperative TRT within 1 year of the index procedure and after the procedure were identified and matched 1:5 to controls without TRT use using propensity score matching. Matching was performed based on age, gender, and Elixhauser comorbidity index (ECI). Postoperative complications were assessed at 90 days and 2 years. Multivariable logistic regressions, accounting for the comorbidity components of the ECI, were employed to compare complications between groups. Rates of postoperative complications were compared using odds ratios (OR) with 95% confidence intervals (CI). Statistical significance was indicated at a p-value of less than 0.05.
Results:
The matched cohort included 167 patients on exogenous TRT and 806 controls. There were no differences in rates of venous thromboembolism (DVT or PE), pneumonia, UTI, wound dehiscence, sepsis, acute kidney injury, surgical site infection, ED visits, or readmissions between patients on TRT and controls within 90 days. Additionally, there were no differences in all cause revision, prosthetic joint infection, or aseptic loosening between TRT users and controls within 2 years.
Conclusion:
Preoperative TRT was not associated with increased postoperative complications, healthcare utilization, or surgical complications after TAA. These findings suggest that TRT use prior to surgery may not adversely impact outcomes in TAA patients.
