Using administrative data from the province of Ontario, the authors performed a retrospective, population-based cohort study of patients >66 years old in Ontario undergoing a first-time THA/TKA between April 1, 2003 and March 31, 2013. The authors looked back to identify patients who underwent cystoscopy or TURP within two years of a THA/TKA. Adjusting for relevant covariates, the authors performed Cox proportional hazard modeling to assess the association between prior urologic procedure and prosthetic joint infection requiring hospital admission.
The authors identified a total of 113 061 patients who met inclusion criteria (44 495 THA and 68 566 TKA). Median age was 74 years, and 40% were male.
A total of 1095 (2.5%) patients had a TURP within two years of THA/TKA. In multivariate analysis TURP was a significant risk factor for peri–prosthetic joint infection (HR 3.42; 95% CI 1.29–9.10; p=0.01).
The authors also assess the association between prior UTI and acute urinary retention. UTI was associated with an increased risk of joint infection (HR 1.21) while acute urinary retention was not associated with such a risk (HR 0.99).
The authors conclude that contemporary cystoscopy is a very non–invasive procedure and does not appear to be associated with a significant risk of a subsequent peri–prosthetic joint infection. This is contrasted with TURP, which is a more invasive procedure and does appear to be associated with an increased risk of peri–prosthetic joint infections. This has implications for the rational use of antibiotic prophylaxis and should be taken into account when updating societal antibiotic prophylaxis guidelines.
However, this study design and the resulting data are perhaps more informative for orthopedic surgeons who are operating on patients with a prior urologic history. Advice for urologists performing cystoscopy or TURP on patients with a prior history of joint arthroplasty cannot be drawn from these data and analysis considering this question would provide helpful guidance for urologists.
Presented by: Nahid Punjani, MD, Western University
Co-authors: Brent Lanting, Andrew McClure, Blayne Welk
Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJD at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia