Is there any benefit in pre-operative urinary analysis before elective total joint replacement?

Area of Science:

• Urology
• Orthopedic Surgery
• Infectious Diseases

Background:

• Asymptomatic bacteriuria (ASB) management before elective joint replacement is debated.
• Current practice often involves screening and treating ASB, despite a lack of clear evidence.

Purpose of the Study:

• To evaluate the necessity of pre-operative screening and treatment for ASB in patients undergoing elective hip and knee replacement.

Main Methods:

• Prospective observational cohort study.
• Urine analyses pre-operatively and on post-operative day 3.
• Exclusion of patients with symptomatic urinary infections or catheters.
• Three-month post-discharge surveillance via questionnaires.

Main Results:

• 36% of 510 patients had pre-operative ASB; 41% had bacteriuria post-operatively.
• Pathogens differed between pre- and post-operative samples in 51% of patients.
• Only 5% developed symptomatic urinary infections, with unrelated organisms.
• Symptomatic infections were successfully treated without affecting joint replacement outcomes.

Conclusions:

• Pre-operative screening and treatment for ASB are not indicated before elective hip and knee replacement.
• The low incidence of symptomatic post-operative urinary infections and their successful treatment support this conclusion.