Budin Jacob S, Waters Timothy L, Collins Lacee K, Cole Matthew W, Winter Julianna E, Delvadia Bela P, Iloanya Michael C, Sherman William F
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA.
Arthroplast Today. 2024 Mar 14;27:101355. doi: 10.1016/j.artd.2024.101355. eCollection 2024 Jun.
Urinary incontinence has been linked to worse postoperative pain, decreased physical function, and reduced quality of life in patients following total joint arthroplasty. The purpose of this study was to analyze whether incontinence is associated with increased postoperative medical and joint complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
A retrospective cohort study was conducted using a national insurance database. Thirty-two thousand eight hundred eleven patients with incontinence who underwent primary THA were identified and matched 1:4 with 129,073 patients without incontinence. Ninety-one thousand nine hundred thirty-five patients with incontinence who underwent primary TKA were matched 1:4 with 367,285 patients without incontinence. Medical and joint complication rates at 90 days and 2 years, respectively, were then compared for patient cohorts using multivariable logistic regressions.
Patients who underwent primary THA with incontinence had statistically higher rates of dislocation, periprosthetic fracture, aseptic revisions, and overall joint complications compared to controls. Patients who underwent primary TKA with incontinence had higher rates of mechanical failure, aseptic revision, and all-cause revision compared to controls.
This study demonstrated an association between patients with incontinence and higher rates of dislocation, periprosthetic fractures, aseptic revisions, and overall joint complications following primary THA compared to controls. Patients with incontinence experience higher rates of mechanical failure, aseptic revision, and all-cause revision following TKA compared to controls. As such, perioperative management of urinary incontinence may help mitigate the risk of postoperative complications.
尿失禁与全关节置换术后患者更严重的术后疼痛、身体功能下降及生活质量降低有关。本研究的目的是分析尿失禁是否与初次全髋关节置换术（THA）和全膝关节置换术（TKA）后术后医疗及关节并发症增加相关。
使用国家保险数据库进行一项回顾性队列研究。确定了32811例接受初次THA的尿失禁患者，并按1:4与129073例无尿失禁患者进行匹配。91935例接受初次TKA的尿失禁患者按1:4与367285例无尿失禁患者进行匹配。然后使用多变量逻辑回归比较患者队列在90天和2年时的医疗及关节并发症发生率。
与对照组相比，接受初次THA且有尿失禁的患者脱位、假体周围骨折、无菌性翻修及总体关节并发症的发生率在统计学上更高。与对照组相比，接受初次TKA且有尿失禁的患者机械性故障、无菌性翻修及全因翻修的发生率更高。
本研究表明，与对照组相比，尿失禁患者在初次THA后脱位、假体周围骨折、无菌性翻修及总体关节并发症的发生率更高。与对照组相比，尿失禁患者在TKA后机械性故障、无菌性翻修及全因翻修的发生率更高。因此，围手术期尿失禁管理可能有助于降低术后并发症风险。
