Orthopedic Aspects of Musculoskeletal Disease in the Lower Extremities

Habermann, Edward T.

doi:10.1016/s0749-0690(18)30753-5

Clinics in Geriatric Medicine

1988

DOI: 10.1016/s0749-0690(18)30753-5

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Orthopedic Aspects of Musculoskeletal Disease in the Lower Extremities

Edward T. Habermann

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Cited by 2 publications

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“…More than 100,000 knee replacements are performed yearly in the United States, 1 and 90% of these patients are aged 55 and older. 2,3 Older patients have slower recovery of ambulatory function and strength in knee extensors than younger patients 4,5 and are more likely to require prolonged hospitalization or inpatient rehabilitation postoperatively.…”

mentioning

confidence: 99%

Preoperative Supraphysiological Testosterone in Older Men Undergoing Knee Replacement Surgery

Amory¹,

Chansky

et al. 2002

J American Geriatrics Society

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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 Ϯ standard deviation was nonsignificantly reduced in the T group (5.9 Ϯ 2.4 days vs 6.8 Ϯ 2.5 days; P ϭ .15). At postoperative Day 3, there was a significant improvement in ability to stand (mean FIM score 5.2 Ϯ 1.0 vs 4.0 Ϯ 1.1; P ϭ .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. J Am Geriatr Soc 50:1698-1701, 2002. Key words: arthritis; arthroplasty; FIM; rehabilitation K nee replacement surgery is associated with beneficial outcomes in appropriately selected patients. More than 100,000 knee replacements are performed yearly in the United States, 1 and 90% of these patients are aged 55 and older. 2,3 Older patients have slower recovery of ambulatory function and strength in knee extensors than younger patients 4,5 and are more likely to require prolonged hospitalization or inpatient rehabilitation postoperatively. 4 Levels of testosterone (T) fall as men age, 6 and supplementation with T can improve strength in older hypogonadal men. 7 Recently, T was shown to improve rehabilitation outcomes in older men with low-normal serum T levels during an 8-week inpatient rehabilitation stay. 8 Muscle strength and protein synthesis occur shortly after administration of exogenous T, 9 and relatively low dosages of T result in improved strength after 1 month in older men. 10 In young men, supraphysiological dosing of T enanthate results in dramatic exercise-independent increases in strength, muscle size and fat-free body mass without adverse affects on lipids, prostate-specific antigen (PSA), mood or behavior. 11,12 Because strength plays such a pivotal role in recovery from a joint replacement operation, we hypothesized that short-term supraphysiological T therapy might improve postoperative outcomes in older men undergoing knee replacement surgery. Therefor...

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mentioning

confidence: 99%

Preoperative Supraphysiological Testosterone in Older Men Undergoing Knee Replacement Surgery

Amory¹,

Chansky

et al. 2002

J American Geriatrics Society

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Rehabilitation of Fractures in the Elderly

Mehta

Nastasi

1993

Clinics in Geriatric Medicine

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Orthopedic Aspects of Musculoskeletal Disease in the Lower Extremities

Cited by 2 publications

References 40 publications

Preoperative Supraphysiological Testosterone in Older Men Undergoing Knee Replacement Surgery

Preoperative Supraphysiological Testosterone in Older Men Undergoing Knee Replacement Surgery

Rehabilitation of Fractures in the Elderly

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