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J Wrist Surg
DOI: 10.1055/a-2781-2579
Scientific Article

Testosterone Replacement Therapy Is Associated with a Higher Rate of Revision and Malunion/Nonunion After Distal Radius ORIF

Authors

  • Ahmad R. Alhankawi 

    1   Mayo Clinic Alix School of Medicine, Phoenix, Arizona, United States

  • Collin L. Braithwaite

    2   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Phoenix, Arizona, United States

  • Jasmine K. M. Lopez

    1   Mayo Clinic Alix School of Medicine, Phoenix, Arizona, United States

  • Alejandro M. Holle

    1   Mayo Clinic Alix School of Medicine, Phoenix, Arizona, United States

  • Sean P. Renfree

    2   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Phoenix, Arizona, United States

  • Katelyn T. Koschmeder

    2   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Phoenix, Arizona, United States

  • Eugenia Lin

    2   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Phoenix, Arizona, United States

  • Kevin J. Renfree

    2   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Phoenix, Arizona, United States
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Abstract

Background

Despite the reported benefits of testosterone replacement therapy (TRT), prior studies have shown that TRT is correlated with increased incidence of adverse outcomes after orthopedic procedures. There is a paucity of literature assessing the outcomes of patients on preoperative TRT undergoing distal radius open reduction and internal fixation (DR-ORIF). Our purpose was to evaluate rates of surgical and medical complications in patients on TRT undergoing DR-ORIF with a matched control cohort.

Materials and Methods

The PearlDiver database was queried for patients who used TRT within 3 months prior to the index procedure. Patients were matched 1:4 with nonuser controls using propensity score matching. Matching was conducted based on age, Elixhauser Comorbidity Index, hypogonadism, osteoporosis, and other comorbidities. Complications were assessed at 90 days and 2 years. Statistical analyses were conducted using chi-square tests. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for each complication. Statistical significance was determined at a p-value of < 0.05.

Results

The matched group included 657 TRT users and 2,236 controls. There were significant differences in depression (control: 40.6% vs. TRT: 45.7%, p = 0.02) and rates of hypogonadism (control: 74.1% vs. TRT: 77.9%, p = 0.05) between the groups. No other statistically significant demographic or characteristic differences were noted. TRT use was not associated with increased surgical or medical complication rates at 90 days postoperatively. At 2 years, TRT use was associated with a greater incidence of revision (OR: 2.80, 95% CI: 1.34–5.85) and nonunion (OR: 2.76, 95% CI: 1.59–4.81). There were no other associations noted at 2 years.

Conclusion

Preoperative TRT was associated with an increased risk of revision surgery and nonunion at 2 years postoperatively. No other significant associations in the risk of major or minor complications were observed.

Level of Evidence

Level III

Keywords

TRT - DR-ORIF - ICD - CPT

Supplementary Material



Publication History

Received: 29 August 2025

Accepted: 04 January 2026

Article published online:
14 January 2026

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