A blockbuster study presented at the 2026 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting has sent shockwaves through the orthopedic and wellness communities: patients on testosterone replacement therapy (TRT) face significantly higher rates of serious complications after total knee and hip replacement surgery. For the millions of men—and a growing number of women, currently using TRT for age-related hormone decline, low energy, and body composition goals, this research demands attention and a thoughtful conversation with your physician.
As an orthopedic surgeon who also manages hormone replacement therapy protocols, I occupy a unique position at the intersection of these two disciplines. The findings are concerning, but they are not a reason to panic, they are a reason to plan.
The Science: What the AAOS 2026 Data Actually Shows
The study, presented by researchers from a major academic medical center, analyzed more than 13,000 patients who underwent total knee arthroplasty (TKA), comparing outcomes between those who had used TRT in the 12 months before surgery and matched controls who had not. The results were striking across every time horizon measured.
Within 90 days of surgery, TRT users had higher rates of pulmonary embolism (1.6% versus 1.2%), pneumonia (3.3% versus 1.9%), acute kidney injury (4.2% versus 2.9%), and sepsis (1.9% versus 1.1%). At one year, the gaps persisted and widened: deep vein thrombosis (4.5% versus 3.3%), cardiac events (3.0% versus 2.4%), and kidney injury (7.9% versus 5.2%). Most concerning for joint replacement patients, periprosthetic complications, joint infection, fracture around the implant, loosening, and instability, were all significantly elevated at both one and five years post-surgery.
A companion study examining total hip arthroplasty found nearly identical patterns: TRT users had higher rates of DVT, pneumonia, sepsis, periprosthetic infection, fracture, dislocation, and revision surgery at every measured interval out to five years.
The proposed mechanisms are multifactorial. Testosterone influences coagulation pathways (increasing thrombotic risk), modulates immune function (potentially impairing wound healing and infection resistance), affects bone remodeling (altering the bone-implant interface), and may impact the periarticular soft tissue envelope that provides joint stability. The study does not prove causation, but the associations are robust and clinically significant.
The Solution at P.O.W.: Integrated Hormone and Surgical Planning
At Prisk Orthopaedics and Wellness, we are uniquely positioned to address this challenge because we manage both sides of the equation. Unlike a typical orthopedic practice that may not know a patient is on TRT, or a hormone clinic that has no involvement in surgical planning, our integrated model ensures that every relevant clinical variable is accounted for before, during, and after surgery.
For patients on TRT who may need joint replacement, our approach includes comprehensive pre-operative hormone evaluation with laboratory assessment of testosterone levels, estradiol, hematocrit, coagulation markers, and inflammatory indicators. We collaborate with the patient to develop a perioperative hormone management plan, which may include temporary dose reduction or cessation of TRT in the weeks surrounding surgery, depending on the individual risk profile.
We also implement enhanced thromboprophylaxis protocols for TRT users, recognizing their elevated baseline risk of clotting, and extend postoperative monitoring for the infection and mechanical complications identified in the AAOS data. The goal is not to deny patients the benefits of appropriately prescribed TRT, but to ensure that when surgery is necessary, the hormonal environment is optimized for healing rather than working against it.
This is precisely the kind of nuanced, patient-specific decision-making that gets lost when hormone therapy and orthopedic care exist in separate silos. If you are on TRT and anticipating any orthopedic surgery, not just joint replacement, this conversation needs to happen well in advance.
Take the Next Step
If you are on testosterone therapy and facing joint replacement or any orthopedic procedure, schedule a consultation at orthoandwellness.com. Dr. Prisk’s dual expertise in orthopedic surgery and hormone management ensures your surgical plan accounts for every variable, so you heal faster, safer, and stronger.
