Abstract
OBJECTIVES: Periprosthetic joint infections (PJIs) are devastating complications after total shoulder arthroplasty (TSA). While it has been shown that increased serum testosterone levels may increase the concentration of skin flora, it is unknown how this correlates clinically with the risk of infection/reoperation. Therefore, we sought to evaluate if supplemental testosterone increases the risk of infection and reoperation after TSA. METHODS: We retrospectively reviewed 448 males who underwent TSA between January 1, 2017 and December 31, 2021 who were prescribed supplemental testosterone within 1 year prior to TSA using a commercial claims database. These patients were matched 1:5 to 2240 patients who were not prescribed supplemental testosterone based on year of TSA, age, geographical region, inpatient or outpatient TSA, and comorbidities within 30 days preoperatively including hypertension, hyperlipidemia, diabetes, obesity, smoking, alcohol abuse, and Charleson Comorbidity Index (CCI) using Mahalanobis nearest neighbor matching. Univariable and multivariable analyses were performed. Significance was set at p < 0.05. RESULTS: Patients prescribed supplemental testosterone were younger (mean = 60.5 versus 61.3 years old, p = 0.04), but otherwise demographics were similar between cohorts (Table 1). Mean follow-up was 1.5 years. At 2 years postoperatively, patients prescribed testosterone had a higher cumulative incidence for reoperation for infection at 2.0% compared to 0.9% for those who were not prescribed testosterone (p = 0.04). Multivariable analysis demonstrated that preoperative supplemental testosterone (OR = 2.6, 95% CI = 1.03-6.6, p=0.04), diabetes (OR = 2.9, 95% CI = 1.1-7.9, p=0.04), and alcohol abuse (OR = 11.4, 95% CI=2.2-60.1, p = 0.004) were risk factors for reoperation for infection (Table 2). At 2 years postoperatively, patients prescribed testosterone had a higher cumulative incidence for overall reoperation at 9.6% compared to 4.0% for those who were not prescribed testosterone (p < 0.001). Multivariable analysis showed that supplemental testosterone was found to be risk factor for overall reoperation (OR = 2.1, 95% CI = 1.3-3.2, p = 0.001) (Table 3). CONCLUSIONS: Patients prescribed supplemental testosterone had a higher risk of all cause reoperation and reoperation for infection after TSA. Further research is needed to understand the mechanism by how testosterone increases the risk of reoperation after TSA.