Increased Medical Complications in Men with Low Testosterone Undergoing Knee Replacement

Abstract

Background

Research Regarding The Impact Of Hypogonadism Following Primary Total Knee arthroplasty (TKA) is limited. Therefore, the purpose of the study was to investigate whether patients with hypogonadism undergoing primary TKA are at increased odds of: (1) medical complications; (2) revisions; (3) in-hospital lengths of stay (LOS); and (4) cost of care.

Methods

A Humana patient-population consisting of 8 million lives was retrospectively analyzed from 2007 to 2017 using International Classification of Disease, 9thRevision (ICD-9) codes. Patients were filtered by male sex and patients with hypogonadism were matched to controls in a 1:4 ratio according to age and medical comorbidities. The query yielded 8,393 patients with (n=1,681) and without (6,712) hypogonadism undergoing primary TKA. Primary outcomes analyzed included: medical complications, revision rates, in-hospital LOS, and cost of care. Logistic regression analysis was used to calculate odds ratios (OR) 90-day medical complications and 2-year revisions. Welch’s t-test was used to test for significance in LOS and cost of care between cohorts. A p-value less than 0.05 was considered statistically significant.

Results

Hypogonadal patients undergoing primary TKA were found to have increased incidence and odds (9.45 vs. 4.67%; OR: 2.12, p<0.0001) of developing 90-day medical complications. Hypogonadal patients undergoing primary TKA were found to have a greater incidence and odds (3.99 vs. 2.80%; OR: 1.89, p<0.0001) of 2-year revisions. Hypogonadal patients had a 6.11% longer LOS (3.47 days vs. 3.27 days, p=0.02) compared to controls, and incurred greater 90-day costs ($15,564.31 vs. $14,856.69, p=0.018) compared to controls.

Conclusion

This analysis of over 1,600 patients demonstrates that patients with hypogonadism undergoing primary TKA have greater odds of postoperative medical complications, revisions, increased LOS and cost of care.