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The hosts' susceptibility to infection depends on several factors. The integrity of the skin and mucous membranes helps protect the body against microbial attacks. When the skin is altered, the chance of infection, limb loss, and even death increases.
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Does Intermittent Catheterization Compared to Indwelling Catheterization Decrease the Risk of Periprosthetic Joint

Luke J Garbarino1, Peter A Gold1, Hiba K Anis2

  • 1Department of Orthopaedic Surgery, Northwell Health, New York, NY.

The Journal of Arthroplasty
|March 21, 2020
PubMed
Summary

Indwelling catheters after total knee arthroplasty (TKA) increase the risk of periprosthetic joint infections (PJIs). Intermittent catheterization does not raise PJI risk, suggesting it may be a safer alternative for TKA patients needing urinary management.

Keywords:
complicationsindwelling cathetersintermittent cathetersperiprosthetic joint infectiontotal knee arthroplastyurinary catheters

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Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Medical Device Safety

Background:

  • Urinary retention is common after total knee arthroplasty (TKA), often managed with catheterization.
  • Indwelling catheters are questioned for their role as infection niduses, potentially increasing periprosthetic joint infection (PJI) risk.
  • The comparative risk of PJI between intermittent and indwelling catheterization post-TKA remains unclear.

Purpose of the Study:

  • To compare the risk of postoperative periprosthetic joint infections (PJIs) following intermittent versus indwelling urinary catheterization after TKA.
  • To evaluate the association between different urinary catheterization methods and PJI development in TKA patients.

Main Methods:

  • A retrospective study analyzed data from 9123 TKAs across 15 hospitals between 2017-2019.
  • Patient data included demographics, comorbidities, BMI, and catheterization type (indwelling, intermittent, or both).
  • Univariate and multivariate analyses assessed the association between catheterization type and PJI development at a mean follow-up of 14 months.

Main Results:

  • Periprosthetic joint infections (PJIs) occurred in 2.3% of patients with bladder catheterization versus 1.1% without (P=.002).
  • Multivariate analysis identified indwelling catheter use (OR 2.647, P<.001) as a significant risk factor for PJI.
  • Intermittent catheterization (OR 1.249, P=.668) or combined use (OR 1.171, P=.828) did not significantly increase PJI risk.

Conclusions:

  • Indwelling urinary catheterization, but not intermittent catheterization, is associated with an increased risk of PJI after TKA.
  • Limiting the duration of indwelling catheter use may help reduce the incidence of PJIs in TKA patients.
  • Intermittent catheterization presents a potentially safer alternative for managing urinary retention post-TKA to mitigate infection risk.