Preoperative supraphysiological testosterone in older men undergoing knee replacement surgery

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.