Coden Gloria, Grant Andrew, Kuznetsov Mikhail, Smith Eric L
New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA, 02120, USA.
J Orthop. 2024 Sep 13;61:47-53. doi: 10.1016/j.jor.2024.09.002. eCollection 2025 Mar.
Prescription testosterone usage in the United States declined after 2013 following reports of its association with myocardial infarction and stroke. However, more recently there has been a documented increase in testosterone prescriptions. Recently, testosterone levels have also been hypothesized to increase infection risk in patients undergoing elective shoulder arthroplasty. Furthermore, testosterone may increase the risk of venous thromboembolism. These complications are perioperative concerns for total hip and knee arthroplasties (THA/TKA). Therefore, the purpose of our study is to identify trends in the incidence of testosterone prescriptions in patients who underwent THA/TKA with respect to geographical population data.
We retrospectively reviewed 40,711 primary THAs and 50,893 primary TKAs performed in males between 1/1/2016 and 12/31/2021 using a commercial claims database. Records were reviewed for demographics, geographical location, and supplemental testosterone prescriptions within 1 year prior to surgery. Patient Metropolitan Statistical Area (MSA) was assessed with respect to United States Census Population Data.
We identified 91,604 males who underwent primary THA (n = 40,711) or TKA (n = 50,893). For THA/TKA, patients who were younger had a higher likelihood of having a supplemental testosterone prescription (OR = 0.99, 95 % CI [0.99-1.00], p < 0.001). TKA patients (2,507, 4.9 %) had a higher rate of testosterone prescriptions than THA patients overall (1,413, 3.4 %), (OR = 1.44 95 % CI [1.35, 1.54], p < 0.001) as well as within each year.For THA and TKA patients, patients in the Midwest (OR = 1.61, p < 0.001), South (OR = 3.04, p < 0.001), and West (OR = 2.28, p < 0.001) regions all had higher testosterone prescription rates than the Northeast. Patients living in a city (MSA population ≥200,000) were more likely to be prescribed testosterone (OR = 1.20, p = 0.002).
Surgeons conducting TKA/THA should be aware that younger patients, those in higher population areas, and those in the Midwest, South, and West regions are more likely to be prescribed testosterone than those in the Northeast.
2013年后，美国处方睾酮的使用量在有报道称其与心肌梗死和中风相关联后出现下降。然而，最近有记录显示睾酮处方量有所增加。最近，也有人推测睾酮水平会增加接受择期肩关节置换术患者的感染风险。此外，睾酮可能会增加静脉血栓栓塞的风险。这些并发症是全髋关节和膝关节置换术（THA/TKA）围手术期需要关注的问题。因此，我们研究的目的是根据地理人口数据确定接受THA/TKA患者的睾酮处方发生率趋势。
我们使用商业索赔数据库对2016年1月1日至2021年12月31日期间男性患者进行的40711例初次全髋关节置换术和50893例初次全膝关节置换术进行了回顾性分析。审查记录中的人口统计学信息、地理位置以及手术前1年内的补充睾酮处方情况。根据美国人口普查人口数据评估患者的大都市统计区（MSA）。
我们确定了91604例接受初次全髋关节置换术（n = 40711）或全膝关节置换术（n = 50893）的男性患者。对于全髋关节置换术/全膝关节置换术，年龄较小的患者开具补充睾酮处方的可能性更高（OR = 0.99，95% CI [0.99 - 1.00]，p < 0.001）。全膝关节置换术患者（2507例，4.9%）的睾酮处方率高于全髋关节置换术患者总体（1413例，3.4%），（OR = 1.44，95% CI [1.35, 1.54]，p < 0.001），且每年均如此。对于全髋关节置换术和全膝关节置换术患者，中西部（OR = 1.61，p < 0.001）、南部（OR = 3.04，p < 0.001）和西部（OR = 2.28，p < 0.001）地区的睾酮处方率均高于东北部地区。居住在城市（MSA人口≥20万）的患者更有可能被开具睾酮处方（OR = 1.20，p = 0.002）。
进行全膝关节置换术/全髋关节置换术的外科医生应意识到，与东北部地区的患者相比，年轻患者、人口较多地区的患者以及中西部、南部和西部地区的患者更有可能被开具睾酮处方。
