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RESIDENT’S CORNER

Parameters affecting urologic complications after major joint replacement surgery

Jason P. Izard¹, Richard D. Sowery¹, Melanie T. Jaeger², D. Robert Siemens¹

1 Departments of Urology, Queen’s University, Kingston General Hospital, Ontario, Canada
2 Department of Anesthesiology, Queen’s University, Kingston General Hospital, Kingston, Ontario, Canada
Address correspondence to Dr. D. R. Siemens, Department of Urology, Kingston General Hospital, Empire 4, 76 Stuart Street, Kingston, Ontario K7L 2V7 Canada

Canadian Journal of Urology 2006, 13(3), 3158-3163.

Abstract

Introduction and objectives: Peri-operative bladder management after major arthroplasty procedures remains controversial. The purpose of this study was to assess the risk of urological complications in those patients undergoing hip or knee joint replacement. As well, we identified those factors that may affect the likelihood of developing complications.
Methods: Two hundred and twenty-one consecutive patients receiving a total knee or hip arthroplasty were reviewed. The outcomes measured were prolonged urinary retention, as well as urinary tract infections and the development of a septic prosthesis. Statistical significance of any predisposing factors identified was determined using a two-tailed Fisher exact test.
Results: Urological complications in the cohort were common at 47%, with patients having hip arthroplasty being at higher risk (p<0.03). Despite this there was a low incidence of documented infections. Increased rates of urinary retention were identified in those who received intrathecal narcotics (p<0.02), as well as those who suffered from hypertension (p<0.05). Gender and anesthetic techniques (general or regional) did not affect the rate of complications. There was a decrease in urological complications when bladder management included peri-operative catheterization rather than expectant management.
Conclusions: Bladder management is a significant problem for patients after hip and knee arthroplasty as urinary retention was identified in almost half of the patients. Parameters that may identify those with higher risks include patients with hypertension and those who receive intrathecal narcotics. In high-risk patients, the practice of utilizing a catheter peri-operatively may decrease the risk of multiple post-operative catheterizations without increasing the rate of infections.

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