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

Table 3 Summary of the implant-related complications

Ref.	Revision	PJI	PPF	Mechanical loosening
ERT
Mousavi et al[30]	90 days: OR = 1.250, 95%CI: 0.650-2.404, P = 0.503; 2 years: 4.2% vs 2.5%, P = 0.004; 4 years: 5.5% vs 3.4%, P = 0.003; 10 years: 7.0% vs 4.6%, P = 0.002	90 days: OR = 1.706, 95%CI: 0.941-3.093, P = 0.075; 2 years: 3.9% vs 2.9%, P = 0.116; 4 years: 5.1% vs 3.8%, P = 0.060; 10 years: 6.6% vs 4.6%, P = 0.007	90 days: OR 1.193, 95%CI: 0.938-1.517, P = 0.149; 2 years: 10.3% vs 8.2%, P = 0.028; 4 years: 10.7% vs 9.1%, P = 0.092; 10 years: 11.2% vs 9.6%, P = 0.124	90 days: OR = 1.000, 95%CI: 0.417-2.397, P = 1.000; 2 years: 1.2% vs 0.6%, P = 0.033; 4 years: 1.8% vs 0.9%, P = 0.020; 10 years: 2.2% vs 1.5%, P = 0.104
McCormick et al[17]	OR = 1.23, 95%CI: 1.05-1.45, P = 0.0105	OR = 0.87, 95%CI: 0.67-1.12, P = 0.2838	OR = 0.97, 95%CI: 0.70-1.35, P = 0.8692	OR = 1.39, 95%CI: 0.98-1.99, P = 0.0677
Collins et al[32]	TKA: OR = 1.31, 95%CI: 1.17-1.47; THA: OR = 1.11, 95%CI: 0.94-1.30	THA: OR = 1.01, 95%CI: 0.78-1.29	TKA: OR = 0.92, 95%CI: 0.67-1.27; THA: OR = 0.97, 95%CI: 0.72-1.29	TKA: OR = 1.12, 95%CI: 0.90-1.37; THA: OR = 1.45, 95%CI: 1.04-2.00
Prieto-Alhambra et al[22]	HRT ≥ 6 months: OR = 0.62, 95%CI: 0.41-0.94, P = 0.023; HRT ≥ 12 months: OR = 0.48, 95%CI: 0.29-0.78, P = 0.003; preoperative HRT: OR = 1.10, 95%CI: 0.69-1.77, P = 0.70	NR	NR	NR
TRT
White et al[27]	90 days: OR = 1.21, 95%CI: 0.70-2.09, P = 0.488; 1 year: OR = 1.60, 95%CI: 1.07-2.40, P = 0.021; 5 years: OR = 1.48, 95%CI: 1.10-1.99, P = 0.009	90 days: OR = 1.70, 95%CI: 1.03-2.81, P = 0.036; 1 year: OR = 2.05, 95%CI: 1.34-3.14, P < 0.001; 5 years: OR = 1.81, 95%CI: 1.31-2.49, P < 0.001	90 days: OR = 0.67, 95%CI: 0.38-1.21, P = 0.185; 1 year: OR = 0.65, 95%CI: 0.40-1.07, P = 0.086; 5 years: OR = 0.77, 95%CI: 0.52-1.14, P = 0.196	90 days: OR = 1.54, 95%CI: 0.86-2.76, P = 0.145; 1 year: OR = 1.32, 95%CI: 0.88-1.99, P = 0.179; 5 years: OR = 1.40, 95%CI: 1.04-1.88, P = 0.026
Omurzakov et al[28]	1 year: TKA OR = 1.6, 95%CI: 1.2-2.2, P = 0.002; 5 years: OR = 1.5, 95%CI: 1.2-1.8, P < 0.001	1 year: OR = 2.7, 95%CI: 2.0-3.7, P < 0.001; 5 years: OR = 2.3, 95%CI: 1.8-2.8, P < 0.001	1 year: OR = 2.8, 95%CI: 1.6-5.0, P < 0.001; 5 years: OR = 2.7, 95%CI: 1.9-4.0, P < 0.001	1 year: OR = 1.9, 95%CI: 1.3-2.9, P = 0.001
Collins et al[32]	TKA: OR = 1.27, 95%CI: 1.13-1.44; THA: OR = 1.46, 95%CI: 1.21-1.75	THA: OR = 1.67, 95%CI: 1.31-2.09	TKA: OR = 1.53, 95%CI: 1.00-2.29; THA: OR = 1.01, 95%CI: 0.64-1.56	TKA: OR = 1.34, 95%CI: 1.06-1.69; THA: OR = 0.84, 95%CI: 0.56-1.25
Su et al[24]	NR	Within 6 months prior: OR = 1.44, 95%CI: 1.03–2.01, P = 0.042; within 6-12 months prior: OR = 1.18, 95%CI: 0.83-1.68, P = 0.403	NR	NR
Parmar et al[25]	12.0% vs 11.0%, P = 0.335	1.4% vs 1.6%, P = 0.597	0.58% vs 1.05%, P = 0.105	2.5% vs 2.3%, P = 0.596
Ayala-Ortiz et al[21]	NR	NR	NR	NR
Corban et al[26]	1 year: 1.4% vs 0%, P < 0.001; 2 years:1.4% vs 0.2%, P = 0.003; 3 years: 1.4% vs 0.7%, P = 0.03	NR	NR	NR
Coden et al[18]	1 year: 1.30% vs 0.84%, P = 0.01; 2 years: 1.65% vs 1.02%, P < 0.001; 3 years: 1.71% vs 1.08%, P < 0.001; 4 years: 1.71% vs 1.10%, P < 0.001; 5 years: 1.75% vs 1.12%, P < 0.001	NR	NR	NR
Jing et al[31]	3.4% vs 0.3%, P = 0.017	NR	NR	NR

CI; Confidence interval; ERT: Estrogen replacement therapy; NR: Not reported; OR: Odds ratio; PJI: Periprosthetic joint infection; PPF: Periprosthetic fracture; THA: Total hip arthroplasty; TKA: Total knee arthroplasty; TRT: Testosterone replacement therapy.