Preoperative Supraphysiological Testosterone in Older Men Undergoing Knee Replacement Surgery

Authors


Address correspondence to Dr. John K. Amory, MD, University of Washington, Box 356429, 1959 NE Pacific Street, Seattle, WA 98195. E-mail: jamory@u.washington.edu

Abstract

OBJECTIVES: Older patients undergoing knee replacement surgery can recover more slowly than younger patients and require extended rehabilitation. Because administration of supraphysiological testosterone (T) dramatically increases strength, we hypothesized that preoperative T therapy would improve functional recovery and reduce hospital stay in older men undergoing knee replacement surgery.

DESIGN: Double-blinded, placebo-controlled pilot trial.

SETTING: A Veterans Affairs orthopedics clinic and inpatient postoperative unit.

PARTICIPANTS: Twenty-five men, mean age 70, undergoing elective knee replacement.

INTERVENTION: Preoperative, supraphysiological T administration (600 mg T enanthate intramuscularly weekly for 4 weeks) or sesame oil placebo.

MEASUREMENTS: Length of hospital stay and functional ability by Functional Independence Measure (FIM) score.

RESULTS: Mean length of hospital stay ± standard deviation was nonsignificantly reduced in the T group (5.9 ± 2.4 days vs 6.8 ± 2.5 days; P = .15). At postoperative Day 3, there was a significant improvement in ability to stand (mean FIM score 5.2 ± 1.0 vs 4.0 ± 1.1; P = .04) and trends towards improvements in walking and stair climbing in the T group. There were no complications attributable to T therapy.

CONCLUSIONS: In older men undergoing knee replacement surgery, preoperative supraphysiological T administration may confer some clinical benefit. Future studies using longer courses of preoperative T administration in larger numbers of older men undergoing knee replacement surgery are warranted.

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