Perioperative testosterone supplementation improves outcomes of orthopedic surgeries: A Systematic review of heterogeneous studies

Purpose: The purpose of this study is to assess the effect of perioperative testosterone supplementation on orthopedic surgical outcomes.

Methods: Three online databases were searched from database inception until September 2024. Three reviewers independently screened all titles, abstracts, and full-texts of articles investigating perioperative testosterone use in orthopedic surgery. English language studies, human studies, Level I or II randomized controlled trials, and studies examining testosterone supplementation given during the perioperative period of an orthopedic surgery were included. Demographic data, surgical indications, details of testosterone use, and outcomes were recorded and analyzed.

Results: 1,895 records were screened and five RCTs (four Level I; one Level II) were included. One study evaluated patients undergoing elective total knee arthroplasty. One study investigated patients undergoing elective ACL reconstruction. Three studies evaluated the effects of testosterone on patients undergoing hip fracture fixation. 189 patients were included with 84 receiving perioperative testosterone and 105 receiving placebo or a control intervention. One study showed length-of-stay was lower and ability-to-stand significantly improved in the testosterone group, one study revealed significant improvement in body composition and bone mineral density (BMD), one study showed testosterone and protein supplementation improved lean body mass (LBM), functional scores, and health-related quality-of-life scores, one study revealed perioperative testosterone supplementation increased lean mass postoperatively, and one short-term and underpowered study did not show significant improvement in the measured outcomes. The five studies showed heterogeneity in patient populations, procedure type, dosage, duration, testosterone therapy protocol, clinical outcomes, and follow-up duration.

Conclusion: Although evidence regarding orthopedic perioperative use of testosterone replacement therapy is heterogenous, four RCTs reviewed here found that testosterone supplementation improved clinical outcomes, body composition, and BMD. All four studies showed significant improvements in functional independence, BMD, muscle volume in the operative and nonoperative leg, Harris hip score, gait speed, Katz score, LBM, and strength.

Level of evidence: Level II: Systematic Review of Level I and II studies.