Preoperative supraphysiological testosterone in older men undergoing knee replacement surgery
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…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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