AUA 2018: The Impact of Common Urological Complications on the Risk of a Prosthetic Joint Infection

San Francisco, CA USA ( Nahid Punjani, MD, clinical urology resident from Western University, presented on the association between joint infections after total hip or knee arthroplasty (THA or TKA) and urologic complications such as urinary tract infections (UTI) or acute urinary retention (AUR). He began by establishing that PJIs can cause significant patient morbidity and healthcare costs.

For this study, 113,061 Canadian patients from 2003-2013 were analyzed after meeting inclusion criteria and had arthroplasties. The authors examined extensive demographic factors including comorbidities and urologic history before performing a regressive, multivariate analysis to determine significant risk factors.

Of note, the study team found that those having at least 1 UTI following their procedure were more likely to be older, female, have previous antibiotic exposure, cystoscopy or retention and have atrial fibrillation. The patients that had AUR were more likely to be older, male, have medical comorbidities, previous transurethral procedures or cystoscopy, previous Urology visits, and had a general anesthetic administered during their procedure. They also discovered that those having a UTI within 2 years of their procedure were associated with an increased risk of joint infection (p<0.01). This, however, was not found upon analysis of AUR and joint infection (p=0.98).

In conclusion, UTI is associated with increased risk of peri-prosthetic joint infection of TKA or THA, while AUR is not a significant risk factor. Dr. Punjani also stated that each additional UTI increases the risk of PJI within the 2 years following the THA or TKA. Therefore, treatment of symptomatic UTIs in their patient population could prevent prosthetic joint infection. A variety of questions regarding the study importance were asked, to which Dr. Pujani explained that this could ensure consistent guidelines to UTI and AUR treatment as it varies across fields such as the American Urological Association guidelines and the American Orthopedic Association guidelines. This could additionally slow antibiotic resistance as less antibiotics would be prescribed needlessly.

Presented by: Nahid Punjani

Written by: Vinay Cooper, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA