Associations of estrogen vs testosterone replacement therapy with complications after total joint arthroplasty: A systematic review

doi:10.5312/wjo.124852

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 17, Issue 10

This Article

(0)

(4)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Orthopedics

ISSN

2218-5836

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Systematic Reviews

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Oct 18, 2026; 17(10): 124852
Published online Oct 18, 2026. doi: 10.5312/wjo.124852

Associations of estrogen vs testosterone replacement therapy with complications after total joint arthroplasty: A systematic review

Xing-Chun Huang, Zhen-Kun Duan, Yu-Ji Zhang, Hua-Jie Huang, Ming Ma, Cong Tian, Jin-Min Liu, Bin Geng

Xing-Chun Huang, Zhen-Kun Duan, Yu-Ji Zhang, Hua-Jie Huang, Ming Ma, Cong Tian, Jin-Min Liu, Bin Geng, Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China

Co-first authors: Xing-Chun Huang and Zhen-Kun Duan.

Author contributions: Huang XC and Geng B conceived and designed the study; Huang XC, Duan ZK, Huang HJ, Zhang YJ, and Liu JM performed the data curation; Duan ZK, Huang HJ, and Zhang YJ conducted the formal analyses; Huang XC and Duan ZK wrote the original draft of the manuscript; Huang XC and Geng B conducted the subsequent review and editing of the manuscript; Ma M contributed to the investigation, methodology, and provision of resources; Tian C was responsible for validation and software; Geng B secured the funding and supervised the project; All authors have read and approved the final version of the manuscript for publication. Huang XC and Duan ZK made crucial and indispensable contributions towards the completion of the project and thus are qualified as the co-first authors of the paper.

AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.

Supported by Natural Science Foundation of Gansu Province for Distinguished Young Scholars, No. 22JR5RA943; Science and Technology Project of Gansu Province, No. 23JRRA1500; Talent Innovation and Entrepreneurship Project in Chengguan District, Lanzhou City, No. 2025-rc-8; and Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital, No. CY2025-ZD-01.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Bin Geng, MD, Department of Orthopedics, The Second Hospital of Lanzhou University, No. 82 Cuixingmen, Chengguan District, Lanzhou 730030, Gansu Province, China. cxxxf@foxmail.com

Received: June 26, 2026
Revised: August 8, 2026
Accepted: August 31, 2026
Published online: October 18, 2026
Processing time: 113 Days and 1.6 Hours

Abstract

BACKGROUND

The populations undergoing total joint arthroplasty (TJA) and those receiving hormone replacement therapy (HRT) overlap considerably, as both predominantly comprise older adults. HRT includes estrogen RT (ERT) and testosterone RT (TRT). Whether these hormonal interventions influence postoperative medical complications (e.g., thromboembolism, acute kidney injury, cardiac events) or implant-related outcomes (e.g., infection, loosening, revision) remains uncertain. Existing studies provide conflicting results, and a direct comparison between ERT and TRT is lacking.

AIM

To systematically compare the associations of ERT and TRT with complications following TJA.

METHODS

PubMed, EMBASE, Web of Science, and Cochrane Library were searched through April 2026. Two reviewers independently screened studies, extracted data, and assessed bias. We examined medical complications, including venous thromboembolism (VTE), acute kidney injury (AKI), cardiac events, pneumonia, sepsis, blood transfusion, together with implant-related outcomes, including revision surgery, periprosthetic joint infection (PJI), periprosthetic fracture, and mechanical loosening. A narrative synthesis was performed due to design and clinical heterogeneity. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and was registered (PROSPERO: CRD420261366259).

RESULTS

A total of 15 studies met the inclusion criteria; 11 reported medical complications and 13 reported implant-related outcomes. ERT yielded mixed, procedure-specific results: Certain total knee arthroplasty (TKA) cohorts had reduced risks of deep vein thrombosis and blood transfusion, while others demonstrated elevated risks of TKA cardiac complications, total hip arthroplasty (THA) mechanical loosening, and total shoulder arthroplasty revision. By contrast, TRT showed a more consistent association with increased risks of PJI, AKI, and revision surgery, although several cohorts found no significant association with VTE after THA, periprosthetic fracture, or blood transfusion.

CONCLUSION

Evidence suggests inconsistent perioperative associations for ERT in TJA, whereas TRT may be linked to higher odds of PJI and AKI. However, heterogeneity and observational design limitations preclude causal inference, thus requiring prospective studies.

Keywords: Total joint arthroplasty; Hormone replacement therapy; Estrogen replacement therapy; Testosterone replacement therapy; Postoperative complications

Core Tip: This study compared the associations of estrogen replacement therapy (ERT) and testosterone RT (TRT) with both medical and implant-related complications after total joint arthroplasty. The results indicated that existing clinical evidence on perioperative ERT remains contradictory, while TRT may be associated with elevated odds of periprosthetic joint infection and acute kidney injury. Nevertheless, these findings are inconsistent. Given substantial heterogeneity and the observational design of the included studies, no definitive conclusions can be drawn; prospective research is urgently needed to optimize perioperative hormone management.