PREDICTION OF POST-OPERATIVE URINARY RETENTION FOLLOWING HIP AND KNEE ARTHROPLASTY IN A MALE POPULATION.

Abstract

Introduction: Urinary retention is a significant complication following hip and knee arthroplasty. Published literature has shown that the insertion of a catheter post-op is associated with an increased incidence of deep joint sepsis, however, pre-operative catheterisation has not.

The International Prostate Symptom Score (IPSS) is an internationally validated scoring system used by Urologists to assess the severity of obstructive urinary symptoms and response to treatment.

The purpose of this study was to quantify the incidence of urinary retention following major joint arthroplasty in an elective orthopaedic unit and to investigate whether a patient’s pre-operative IPSS score could be used to predict the likelihood of post-operative urinary retention.

Patients and Methods: Over a 9 month period, 118 patients were enrolled prospectively into this study. 28 patients were admitted for knee replacement(TKR) and 90 patients for hip replacement (THR). All patients were asked to fill out an IPSS questionnaire form on admission. Demographics including age, mode of anaesthetic, intra-operative blood loss and operative time were recorded. Results: In our study group of 118 patients, 43(36.4%) developed urinary retention postoperatively. 29(32.2%) patients following THR developed urinary retention, whereas 14(50%) of the men who had a TKR developed urinary retention post-op. Of the 25 patients with a pre-operative IPSS score > /=10, 14(56%) went into retention. The mean pre-operative IPSS score was 7.74 for those who went into retention, compared to 5.0 for the other patients (p < 0.05). Type of anaesthesia, blood loss and operative time were non-contributory.

Conclusion: This study shows a high rate of post-operative urinary catheterisation in our patient group. Despite the mean IPSS score being higher in patients requiring catheterisation, our results did not show any conclusive evidence that this scoring system could be used to predict the development of post-operatively urinary retention in patients presenting for hip or knee arthroplasty.