TRT Before Knee Replacement: New Review Informs Surgical Planning

On October 17, 2026, Cureus published a narrative review describing associations between preoperative testosterone replacement therapy (TRT) and selected complications after total knee arthroplasty (TKA). The knee-replacement findings came from observational research summarized by the review rather than a trial conducted by its authors.

Why does this matter for service members and veterans?

For active personnel and veterans preparing for knee replacement, the practical issue is how testosterone treatment fits into surgical planning. The review supports making current TRT use part of the discussion with the orthopedic surgeon and anesthesia team. That discussion should also include the clinician who prescribes testosterone.

This connects hormone care with joint health rather than treating them as unrelated subjects. BattleVet's focus on maintaining long-term capability after military service includes both physical performance and the health decisions that support it. Here, the useful takeaway is better coordination around an existing treatment and a planned operation.

The findings raise questions about clot-related complications and longer-term orthopedic outcomes. Those are different concerns, so they deserve separate attention during surgical planning rather than being grouped into a single claim that TRT makes knee replacement unsafe.

What did the review report after knee replacement?

According to the Cureus review, an observational analysis of 13,250 propensity-matched TKA patients associated preoperative TRT with complications at several follow-up points:

• At 90 days: TRT exposure was associated with pulmonary embolism (PE).
• At one year: TRT exposure was associated with deep-vein thrombosis (DVT).
• At five years: The TRT-exposed group had higher reported risks of periprosthetic joint infection, periprosthetic fracture and revision.

The time points matter. The review describes different outcomes measured over different periods rather than one uniform complication measure. The clot-related findings and the later orthopedic findings should therefore remain distinct when clinicians discuss their relevance.

Cureus also summarizes a separate registry analysis. That analysis found an association between perioperative TRT and PE after TKA, but it did not find an association with DVT after TKA. It also found no association with DVT or PE after total hip arthroplasty.

The registry findings help define the scope of the concern. They do not support extending the knee-replacement PE finding to every clot-related outcome or every type of joint replacement. In particular, the available summaries do not show a uniform thromboembolic signal across datasets and outcomes.

How much confidence should readers place in these findings?

These are observational associations, not proof that TRT caused the complications. The review describes the evidence as heterogeneous. Its narrative-review methods did not include a formal risk-of-bias assessment or grading of certainty.

The summary provides no absolute PE or DVT rates for the knee-replacement comparison. It also gives no effect sizes or absolute rates for the five-year orthopedic outcomes. Those gaps prevent translating the reported associations into a patient's personal probability of a complication or a reliable estimate of the size of the difference.

There is also an important distinction between TRT exposure and testosterone deficiency. The review cautions that prescription or administrative records do not necessarily establish biochemically confirmed low testosterone before treatment. A separate testosterone-deficiency study discussed in the review excluded TRT users, so its findings should not be attributed to TRT.

The cited TKA summary does not identify a veteran-specific cohort. The review's page also does not provide full bibliographic citations for the underlying TRT analyses. Together, these limitations support an individualized clinical discussion rather than a claim that veterans face a distinct risk established by this research.

Should TRT change the preoperative conversation?

The supported practical step is disclosure and coordinated planning, not an automatic decision to stop TRT. The research does not establish that every patient should interrupt treatment or provide a TRT-specific perioperative protocol. Decisions about an individual prescription belong with qualified clinicians who know the patient and the planned procedure.

The review supports making several topics explicit during the preoperative discussion:

• Is current testosterone treatment included in the medication review, including its formulation and prescribing clinician?
• How does the patient's personal clotting history affect the surgical assessment?
• How do other medical conditions and medications affect the plan?
• What postoperative prevention strategy is planned, and how does it fit the individual's overall risk assessment?
• How will the team consider the reported infection, fracture and revision findings alongside clot-related concerns?

These questions keep the discussion focused on the person's circumstances rather than on a headline alone. They also give the surgeon and anesthesia team a clear opportunity to coordinate with the TRT prescriber. The purpose is to bring relevant information into one clinical discussion before decisions are made.

A useful distinction is whether the conversation concerns clot prevention or longer-term orthopedic outcomes. The review raises both subjects. Addressing one should not be treated as automatically resolving the other.

For readers organizing healthcare during the transition to civilian life, this is a practical example of connecting related health decisions. Hormone treatment and an upcoming joint replacement belong in the same care discussion even when different clinicians manage them.

Does the review change hormone testing or physical preparation?

The Cureus article places the arthroplasty findings within a broader discussion of biomarkers related to sarcopenia and physiological reserve. Its broader conclusion is that biomarkers complement established assessment of muscle strength, muscle quantity or quality and physical performance. They do not replace those assessments.

That reinforces a distinction between laboratory information and physical function. A hormone-related finding should contribute to a broader assessment rather than become a stand-alone judgment about readiness for surgery or recovery. The review supports keeping established measures of strength and performance in the picture.

It does not establish a new testing schedule or exercise progression for people using TRT before knee replacement. Personal decisions about diagnostic testing and physical preparation therefore remain with the treating team. The practical shift is to connect the hormone history with the existing surgical assessment rather than add an unsupported protocol.

What should future research resolve for veteran healthcare?

The Cureus review calls for prospective studies that include testosterone measurements before treatment. That approach would help research distinguish endogenous testosterone status from TRT exposure rather than treating them as interchangeable variables.

Future work would be most useful if it addressed clot-related events alongside longer-term orthopedic outcomes. For military and veteran healthcare, the goal is guidance that connects hormone treatment with joint health and physical function while preserving those distinctions.

Will future studies turn these associations into clearer surgical guidance for veterans while separating the effects of testosterone deficiency from those of testosterone treatment?

Sources

1. Biomarkers Related to Sarcopenia and Physiological Reserve in Total Joint Arthroplasty and Other Clinical Populations