Testosterone deficiency (TD) affects a notable portion of the aging male population, leading to muscle loss and reduced bone density. Most men with TD do not receive testosterone replacement therapy (TRT). However, the association of untreated TD on surgical outcomes after total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA), remains unexplored. This study aims to assess whether untreated TD is associated with poorer surgical outcomes in TJA patients without prior TRT. This retrospective cohort study used data from the TriNetX US Research Network, a large claims database including over 95 healthcare organizations and 130 million patients. Male patients undergoing THA or TKA were divided into two groups based on testosterone levels (TD: <300 ng/dL; eugonadal/non-TD: ≥300 ng/dL). Those with TRT before or within 2 years after TJA were excluded. Propensity score matching balanced demographics and comorbidities. Outcomes, including thromboembolic events, infections, prosthetic complications, revision, resection, readmission, and mortality, were assessed at 90 days, 1, and 2 years post-TJA. A total of 133,696 male patients without hormone replacement therapy who underwent THA were analyzed, with 5,400 patients in both TD and eugonadal cohorts after matching. TD patients had a higher risk of deep vein thrombosis and pulmonary embolism at 90 days, 1, and 2 years post-THA compared with their eugonadal counterparts. In the TKA population of 147,203 male patients, 6,658 patients per cohort were matched. TD patients had an increased risk of deep vein thrombosis, aseptic loosening, manipulation, readmission, and revision surgery within two years but lower risk of prosthetic joint infection than eugonadal men. TD is associated with poorer postoperative outcomes in TJA, with distinct patterns observed in THA and TKA. These findings suggest that hypogonadal status should be considered in the perioperative management of patients undergoing TJA.

More than 1 million hip and knee total joint arthroplasties (THAs and TKAs) are performed annually in the United States. While major perioperative complications are relatively uncommon, they may substantially increase healthcare expenditures. The economic impact of individual complications, however, remains poorly defined. This study aimed to assess the effect of major complications on hospital costs and length of stay (LOS). This study analyzed data from 2,361,402 THA/TKA patients in the Premier Healthcare claims database (2006 to 2022). The exposure was the occurrence of major postoperative complications ( e.g. , cardiac, pulmonary, renal, gastrointestinal, infectious, central nervous system, and thromboembolic complications), evaluated individually and in clusters (two coinciding or three or more coinciding). The primary outcome was total cost of hospital stay. Generalized estimating equation models compared costs across groups, reported as percent change with 95% confidence interval. Median costs without complications were $16,802 (interquartile range [IQR], $13,731 to $20,838) for TKA and $17,250 (IQR, $14,072 to $21,355) for THA. In TKA, the highest costs occurred with three or more complications ($35,477; IQR, $26,078 to $52,071), sepsis ($30,633; IQR, $21,748 to $44,530), and myocardial infarction ($28,908; IQR, $21,805 to $38,744). Multivariable models confirmed the greatest adjusted increases with 3 or more complications (+136%), sepsis (+88%), and myocardial infarction (+73%) at the patient level. Frequent complications such as renal failure (+26%), pulmonary complications (+23%), and intensive care unit admission (+61%) emerged as leading drivers of overall costs. LOS accounted for a substantial share of additional costs. In this large national cohort, perioperative complications substantially increased hospital costs, largely via prolonged LOS. Although sepsis, stroke, and myocardial infarction were most expensive per case, the overall healthcare burden was driven by frequent complications and resource use, including intensive care unit admission, acute renal failure, pulmonary complications, mechanical ventilation, and concurrent complications. These findings suggest that targeting frequent complications and resource intensive care processes may yield the greatest impact on reducing hospital expenditures in arthroplasty surgery.

Effect of Esketamine for Patient-Controlled Intravenous Analgesia on Postoperative Sleep Disturbance in the Elderly After Total Hip or Knee Arthroplasty: A Prospective, Randomized, Double-Blind, and Controlled Trial.

Weekend surgery is associated with increased use of hemiarthroplasty for displaced femoral neck fractures: A propensity-matched study.

Anxiety and Depression Symptoms Are Associated With Inferior Outcomes in Patients Undergoing Total Hip Arthroplasty: A Prospective Cohort Study.

Automatic Impactors in Total Hip Arthroplasty: A State-of-the-Art Review.

Increased Mortality Following Periprosthetic Joint Infection After Total Hip Arthroplasty: A Microbiologically Verified Nationwide Cohort of 1,611 PJI Revisions.

Total hip arthroplasty is considered a viable solution to acute and chronic hip injuries, which significantly improves the quality of life of patients. A descriptive and retrospective study was conducted with the aim of evaluating patients who underwent cemented total hip arthroplasty with a RALCA® total hip prosthesis over a decade (2010-2020) at the “Abel Santamaría Cuadrado” Hospital (Pinar del Río). Variables such as age, sex, etiological diagnosis and incidence of associated diseases were taken into account for the research. The Harris Hip Score was used to evaluate the final results. The study universe consisted of all patients who underwent this procedure during the study period (120) and the sample studied was 90 patients. Theoretical, empirical and statistical methods were taken into account, the information was processed in a microcomputer and the results were entered into tables for better study and understanding. Males predominated with 52 patients, the highest number of cases was found between the ages of 61 and 70 years. Primary coxarthrosis was the etiologically most prevalent with 36 patients, arterial hypertension was the most frequent associated disease in 36 cases, and the most frequent postoperative complication was paralytic ileus. With the use of the RALCA® prosthesis in this study, excellent results were obtained in 71 patients when evaluated at 3 years of evolution, with an average of (89.3) in the Harris score.

Arthroplasty plays a crucial role in the management of both acute fractures and failed fracture surgeries around the hip, particularly in the aging population. It is important to explore the indications, benefits, and challenges of total hip arthroplasty in various clinical scenarios, including geriatric acetabular fractures, proximal femur fractures, and cases of failed hip fracture surgery. Acute total hip arthroplasty is increasingly recognized as a viable alternative to open reduction and internal fixation in elderly patients with poor bone quality or preexisting arthritis. When treating patients with failed hip fracture surgeries, total hip arthroplasty serves as a reliable salvage procedure but requires meticulous planning and advanced surgical techniques to address complications such as bone loss, malunion, and infection. The management of fracture-related infections is particularly complex, often necessitating a staged approach to optimize outcomes.

Evidence-Based Advances in Improving Hip Stability in Total Hip Arthroplasty.

Neuraxial versus general anesthesia for primary total hip arthroplasty: A retrospective analysis comparing postoperative outcomes and rates of complications.

Efficacy and Safety of Oral versus Intravenous Administration of Tranexamic Acid in Elective Total Hip Arthroplasty: A Systematic Review and Meta-Analyses of Randomized Controlled Trials.

This study aims to evaluate the incidence and clinical predictors of postoperative urinary retention (POUR) following total joint arthroplasty (TJA) and to evaluate whether preoperative bladder voiding efficiency (BVE) can independently predict POUR. Between September 2023 and May 2024, a total of 200 patients (66 males, 134 females; median age: 69 years; range, 32 to 90 years) scheduled for primary total hip or knee arthroplasty were prospectively analyzed. Patients were classified into POUR (n=33) and non-POUR (n=167) groups. Demographic characteristics, urological history, operative variables, the International Prostate Symptom Scores (IPSS), and bladder scanner measurements were collected and compared. The overall incidence of POUR was 16.5% (33/200). Compared to the non-POUR group, the POUR group exhibited significantly higher IPSS (p<0.001) and lower BVE (p=0.0016). Higher body mass index (p<0.001), hypertension (p<0.001), and diabetes mellitus (p<0.001) were significantly associated with POUR development. Higher preoperative IPSS and lower BVE seem to be independently associated with POUR following TJA. Notably, BVE emerges as a novel and clinically meaningful predictor. Routine preoperative assessment of BVE and IPSS may aid in the early identification of high-risk patients, enabling the implementation of targeted strategies to prevent POUR and its associated complications.

Aspirin Versus Other Anticoagulants for the Initial Prevention of Venous Thromboembolism Following Elective Total Hip and Knee Arthroplasty: An Umbrella Review and Meta-Analysis.

Factors Contributing to the Progression of Osteoarthritis After Rotational Acetabular Osteotomy: A Study of 183 Hips With a Median Follow-Up Period of 14 Years.

Preliminary cadaver study of Surgical Humidification (HumiGard™) demonstrating reduced intra-wound particle counts during total hip arthroplasty.

Successful treatment of multidrug-resistant Staphylococcus aureus surgical site infection following total hip arthroplasty: A case report

Revision rates of porous-coated versus grit-blasted femoral stems in cementless total hip arthroplasty: A systematic review.

A Commentary on Orthopaedic Physician Practice Consolidation-Data Trends and Implications for Total Hip and Knee Arthroplasty.

Efficacy of Debridement, Antibiotics, and Implant Retention in Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis.