Preoperative Supraphysiological Testosterone in Older Men Undergoing Knee Replacement Surgery


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


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.