Department of Orthopaedic Surgery, Northwell Health, New York, NY.
Department of Orthopaedic Surgery, The Cleveland Clinic, Cleveland, OH.
J Arthroplasty. 2020 Jun;35(6S):S308-S312. doi: 10.1016/j.arth.2020.02.055. Epub 2020 Feb 28.
Catheterization for the prophylaxis against or treatment for urinary retention commonly occurs after total knee arthroplasty (TKA). Recent studies have questioned the use of the indwelling catheterization, especially in its potential role as a nidus for infection. We are still unsure of its downstream effects on periprosthetic joint infections (PJIs). Therefore, this study aimed to compare the risks of postoperative PJI following intermittent vs indwelling catheterization after TKA.
Between 2017 and 2019, 15 hospitals in a large health system collected data on patients undergoing TKA. Patient treatments with indwelling catheter only, intermittent straight catheter only, and both indwelling and intermittent straight catheterizations were recorded. Patient demographics, comorbidities, body mass indices, and PJIs were collected from time of surgery to time of data collection at mean 14 months of follow-up. Univariate and multivariate analyses were performed with independent t-tests and multiple linear regression models to compare catheterization treatment types.
A total of 9123 TKAs were performed, with patients receiving indwelling catheter only (62%, n = 734), intermittent straight catheter only (25%, n = 299), or both indwelling and intermittent catheterizations (13%, n = 160). Univariate analyses showed that PJIs occurred in 1.1% of no-catheter patients and 2.3% of patients treated with bladder catheterization (P = .002). Using multivariate analyses, indwelling catheter use (odds ratio [OR] 2.647, P < .001), diabetes (OR 1.837, P = .005), and peripheral vascular disease (OR 2.372, P = .046) were found to have a statistically significant increased risk for PJIs. The use of intermittent straight catheterization (OR 1.249, P = .668) or both indwelling and intermittent (OR 1.171, P = .828) did not increase the risk for PJIs.
Urinary bladder catheterization is commonly required for prophylaxis against or treatment for urinary retention following TKA. The use of a urinary catheter can provide a potential nidus for infection in these patients. This study found that indwelling catheterization, but not intermittent catheterization, was associated with an increased risk for PJI. Surgeons should therefore limit the duration of catheterization in an effort to decrease the risk for PJI.
全膝关节置换术（TKA）后，常进行导尿以预防或治疗尿潴留。最近的研究对留置导尿管的使用提出了质疑，尤其是其作为感染灶的潜在作用。我们仍不确定它对假体周围关节感染（PJI）的下游影响。因此，本研究旨在比较 TKA 后间歇性与留置导尿对术后 PJI 的风险。
在 2017 年至 2019 年期间，一个大型医疗系统的 15 家医院收集了接受 TKA 的患者的数据。记录仅留置导尿管、仅间歇性直导管和同时留置和间歇性直导管的患者治疗情况。从手术时间到数据收集时间（平均随访 14 个月），收集患者的人口统计学、合并症、体重指数和 PJI 数据。采用独立 t 检验和多元线性回归模型进行单变量和多变量分析，以比较导管治疗类型。
共进行了 9123 例 TKA，其中仅接受留置导尿管（62%，n=734）、仅间歇性直导管（25%，n=299）或同时留置和间歇性导管（13%，n=160）的患者。单变量分析显示，无导管患者的 PJI 发生率为 1.1%，膀胱导管化患者为 2.3%（P=0.002）。使用多元分析，留置导尿管使用（比值比[OR]2.647，P<0.001）、糖尿病（OR 1.837，P=0.005）和外周血管疾病（OR 2.372，P=0.046）与 PJI 的风险显著增加相关。间歇性直导管使用（OR 1.249，P=0.668）或同时留置和间歇性（OR 1.171，P=0.828）并未增加 PJI 的风险。
TKA 后常需要导尿以预防或治疗尿潴留。导尿管的使用可能为这些患者的感染提供潜在的病灶。本研究发现，留置导尿管与 PJI 的风险增加有关，而非间歇性导尿管。因此，外科医生应限制导尿管的使用时间，以降低 PJI 的风险。
