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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, 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
Revised: August 8, 2026
Accepted: August 31, 2026
Published online: October 18, 2026
Processing time: 113 Days and 1.6 Hours
Core Tip
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.