Indwelling urinary catheterization was unnecessary in non-drainage total knee arthroplasty: a randomized controlled trial

Thiengwittayaporn, Satit; Uthaitas, Pinyong; Hongku, Natthapong; Tunyasuwanakul, Revit; Limphunudom, Ploynapas; Leelachiewchankul, Fontip

doi:10.1007/s00402-020-03677-z

Cited by 3 publications

(6 citation statements)

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“…The indwelling urinary catheter brings no advantage to the patient undergoing primary TKA; indeed, its avoidance has been described to reduce the risk of UTIs and the time of first postoperative urination without increasing the risk of urinary retention [37,40].…”

Section: Discussionmentioning

confidence: 99%

“…A population of 230 patients who underwent primary no-drainage TKA was included in a recent RCT [40] which showed that the catheterisation for this procedure under combined spinal epidural anaesthesia with short-acting opioid analgesia might not be necessary to preventing postoperative urinary retention. Similar results have been described in retrospective study including patients who underwent primary THA or primary TKA; in fact, the authors concluded that the risk of postoperative urologic complications in their group of patients was not increased by no use of preoperative indwelling urinary catheters [5].…”

Section: Urinary Cathetermentioning

confidence: 99%

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Optimised fast‐track protocols in total knee arthroplasty determine shorter hospitalisation time and lower perioperative/postoperative complications

Compagnoni,

Puglia,

Magnani

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis literature review aims to present evidence‐based clinical recommendations for the eight most debated topics related to perioperative management in total knee arthroplasty: counselling, prehabilitation, transfusion risk, tranexamic acid, drainage, analgesia, urinary catheter and compression stockings.MethodsA multidisciplinary team conducted a systematic review on these topics. The study followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for the literature review and result presentation. The research encompassed articles from 1 January 2009 to 28 February 2023, retrieved through the MEDLINE database via PubMed, Embase database and Cochrane Library.ResultsForty‐five articles were selected. Preoperative counselling has limited evidence for its impact on postoperative outcomes; yet, it can help alleviate surgery‐related anxiety and manage postoperative symptoms. Prehabilitation can also prepare patients for surgery, reducing hospital stays and improving postsurgery functionality. Numerous studies suggest that preoperative Hb levels are independently linked to transfusion risk, with a recommended level of 13 g/dL. Combining intravenous and local tranexamic acid administration is strongly advised to reduce perioperative blood loss, while drainage after primary total knee arthroplasty offers no functional advantages. Employing a multimodal analgesia approach yields better results with reduced opioid usage. Indwelling urinary catheters provide no benefit and avoiding them can lower the risk of urinary tract infections. As for compression stockings, there is insufficient evidence in the literature to support their efficacy in preventing venous thromboembolism.ConclusionThe best‐track protocol has demonstrated its efficacy in reducing hospitalisation time and perioperative/postoperative complications. It is success relies on a collaborative, resource‐adaptive approach led by a multidisciplinary team. Both patients and hospitals benefit from this approach, as it enhances care quality and lowers costs. Several studies have highlighted the significance of a patient‐centred approach in achieving high‐quality care. Creating a novel treatment protocol could be a prospective goal in the near future.Level of EvidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Section: Urinary Cathetermentioning

confidence: 99%

Optimised fast‐track protocols in total knee arthroplasty determine shorter hospitalisation time and lower perioperative/postoperative complications

Compagnoni,

Puglia,

Magnani

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…24 A utilização de sonda vesical em indivíduos que foram submetidos à raquianestesia pode não ser necessário. 25 A aspirina foi mantida por três meses, na dose de 100 mg/dia, para prevenção do infarto, já que a doença isquêmica do coração é a principal causa de morte nos primeiros 90 dias seguintes à artroplastia; a proteção gástrica foi usada por 30 dias pois existe associação de morte por doença relacionada ao sistema digestório após artroplastias. 26 Putnis et al 5 reportaram que o risco de complicações maiores está associado à classificação do ASA !…”

Section: Discussionunclassified

A artroplastia total de joelhos bilateral simultânea pode ser segura

Gali

Brotto

Mello

et al. 2022

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivos Os objetivos deste estudo foram analisar a segurança da artroplastia total bilateral de joelho simultânea (ATJBS) e investigar a satisfação dos pacientes com o procedimento realizado de forma concomitante. Métodos Em um estudo prospectivo, avaliamos 45 pacientes submetidos à ATJBS feita por duas equipes cirúrgicas. A idade média dos pacientes foi 66,9 anos, sendo 33 do gênero feminino (73,3%) e 12 (26,6%) do gênero masculino. No período intra- e pós-operatório foi seguido um protocolo de medidas visando a segurança do procedimento. Avaliamos o tempo de cirurgia, a perda sanguínea pelo hematócrito (Ht) e hemoglobina (Hb), obtidos no primeiro dia de pós-operatório, a porcentagem de pacientes que receberam transfusão de concentrado de hemácias e quantidade de unidades que foram necessárias. Verificamos as complicações no período perioperatório e, ao final de três meses, inquirimos aos pacientes sobre a preferência entre o procedimento simultâneo ou estagiado. Resultados O tempo médio de cirurgia foi de 169 minutos; no pós-operatório houve um decréscimo médio de 28,2% do Ht e de 27,0% da Hb. Ao todo, 16 pacientes (35,5%) receberam transfusão de concentrado de hemácias (média de 1,75 unidades por paciente que precisou de reposição). Tivemos 12 complicações menores (26,6%) e 2 complicações maiores (4,4%); além disso, nenhum paciente teve o diagnóstico clínico de trombose venosa profunda e não houve mortes. Conclusões A ATJBS pode ser considerada um procedimento seguro, se realizada em pacientes selecionados e com um protocolo de cuidados para prevenir complicações. Esse procedimento teve a aprovação unânime dos pacientes.

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“…An RCT by Miller et al evaluated patients who received bupivacaine spinal anesthesia and found no difference in straight catheterization rates between those who received an intraoperative Foley catheter and those who did not (catheter, 2.8% versus no catheter, 9.7%; p = 0.07) 13 . Similarly, an RCT by Thiengwittayaporn et received combined spinal-epidural anesthesia with a short-acting intrathecal opioid (catheter, 2.7% versus no catheter, 5.3%; p = 0.40) 28 . Our study uniquely investigated short-term catheterization as a strategy for mitigating POUR while minimizing the risks associated with prolonged catheterization.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, catheter use to mitigate POUR is controversial. Previous randomized controlled trials (RCTs) reported that up to 2.8% of patients receiving an intraoperative Foley catheter versus 9.7% of patients with no catheter required straight catheterization postoperatively to treat urinary retention in the setting of TJA with neuraxial anesthesia, although this difference did not reach significance 13,28 . Those studies concluded that routine intraoperative catheters were not necessary, despite a more than 3-fold greater rate of straight catheterization events in the no-catheter group.…”

mentioning

confidence: 99%

Short-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA

Weintraub

Yang

Nam

et al. 2022

Journal of Bone and Joint Surgery

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Background: The purpose of this randomized controlled trial was to determine whether a short-term Foley catheter (inserted in the operating room and removed upon arrival to the orthopaedic floor) would reduce the risk of postoperative urinary retention (POUR) in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA).Methods: Three hundred and eighty-eight patients undergoing inpatient primary TKA (n = 228) or THA (n = 160) with spinal anesthesia were randomized to receive a short-term Foley catheter (n = 194) or no Foley (n = 194). There were 143 male and 245 female patients. The primary outcome was POUR, defined as requiring ‡2 straight catheterizations or the placement of an indwelling urinary catheter when indicated by retention of ‡450 mL on bladder scans. Secondary outcomes included urinary tract infections (UTIs) within 3 weeks and the need for ‡1 straight catheterization. A power analysis determined that 194 patients per group were required to detect a 7% minimal clinically important difference in POUR rates at 80% power and alpha of 0.05. Intention-to-treat and as-treated analyses were performed (2 patients received the non-allocated treatment). Outcomes were compared between the groups using univariate and multivariate analyses, with alpha < 0.05.Results: Nine patients developed POUR: 4 in the short-term Foley group and 5 in the control group (2.1% versus 2.6%; p = 1.00). Of those who developed POUR, 8 were male and 1 was female (88.9% versus 11.1%; p = 0.002). Twenty-four patients required ‡1 straight catheterization: 10 in the Foley group and 14 in the control group (5.2% versus 7.2%; p = 0.40). Four patients developed UTIs: 3 in the Foley group and 1 in the control group (1.5% versus 0.5%; p = 0.62) on intention-to-treat analysis, and 4 in the Foley group and none in the control group (2.1% versus 0.0%; p = 0.12) on as-treated analysis. Conclusions:The use of a short-term Foley catheter inserted in the operating room and removed on arrival to the orthopaedic floor does not decrease the rate of POUR.

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Indwelling urinary catheterization was unnecessary in non-drainage total knee arthroplasty: a randomized controlled trial

Cited by 3 publications

References 24 publications

Optimised fast‐track protocols in total knee arthroplasty determine shorter hospitalisation time and lower perioperative/postoperative complications

Optimised fast‐track protocols in total knee arthroplasty determine shorter hospitalisation time and lower perioperative/postoperative complications

A artroplastia total de joelhos bilateral simultânea pode ser segura

Short-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA

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