The Impact of Common Urologic Complications on the Risk of a Prosthetic Joint Infection
Prosthetic infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA) are significant complications, and there are conflicting reports of their association with urologic complications. The purpose of this study is to determine if urinary tract infection (UTI) and acute urinary retention (AUR) are significant risk factors for joint infections after THA or TKA.
This study is a population-based retrospective cohort study of all patients greater than 66 years of age undergoing a THA or TKA in Ontario, Canada between April 1, 2003 and March 31, 2013 (n = 113,061). Cases were reviewed for post-operative UTI requiring presentation to the emergency department or hospital admission within 2 years of joint replacement, as well as acute urinary retention within 30 days of THA/TKA. The primary outcome is joint infection requiring hospital admission following THA and TKA. We hypothesized that both UTI and AUR would increase the risk of subsequent joint infection after arthroplasty.
A total of 113,061 patients met inclusion criteria and had arthroplasties during the study period (44,495 with THA and 68,566 with TKA). Median age was 74 (IQR 70-79). A total of 28,256 (25.0%) had at least one UTI, and were more likely to be older, female, have previous antibiotic exposure, cystoscopy or retention, and have atrial fibrillation. A total of 2,516 (2.2%) patients had AUR within 30 days of procedure, and were more likely to be older, male, have medical comorbidities, previous transurethral procedures or cystoscopy, previous Urology visits and a general anesthetic during their procedure. A total of 1,262 (1.1%) patients had joint infection requiring hospital admission at a median of 86 days (IQR 21-377). In multivariate Cox regression analysis, UTI was associated with an increased risk of joint infection (HR 1.21, 95% CI 1.14-1.28, p<0.01). However multivariate analysis did not demonstrate an association with AUR and joint infection (HR 0.99, 95% CI 0.60-1.64, p=0.98). </p>
UTI is associated with increased risk of peri-prosthetic joint infection of THA or TKA, whereas acute urinary retention is not a significant risk factor. Timely and appropriate treatment of symptomatic UTIs in this patient population may be important in prevention of prosthetic joint infection.
Funding: Western University Department of Surgery Resident Research Grant