Preoperative Supraphysiological Testosterone in Older Men Undergoing Knee Replacement Surgery

• Published in: Journal of the American Geriatrics Society (JAGS) 2002-10, Vol.50 (10), p.1698-1701
• Main Authors: Amory, John K., Chansky, Howard A., Chansky, Kari L., Camuso, Matthew R., Hoey, Chris T., Anawalt, Bradley D., Matsumoto, Alvin M., Bremner, William J.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Androgens; arthritis; arthroplasty; Arthroplasty, Replacement, Knee - rehabilitation; Biological and medical sciences; Double-Blind Method; Elderly people; FIM; Geriatrics; Humans; Injections, Intramuscular; Knee; Knee replacement; Length of Stay; Male; Medical sciences; Men; Middle Aged; Older people; Orthopedic surgery; Postoperative Complications - prevention & control; Premedication; Preoperative Care; Recovery; Recovery of Function; rehabilitation; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Testosterone; Testosterone - administration & dosage; Testosterone - therapeutic use; Treatment Outcome
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1046/j.1532-5415.2002.50462.x

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.