INTRODUCTION: Routine use of perioperative indwelling urinary catheterisation in fast-track total hip arthroplasty (THA) and total knee arthroplasty (TKA) is still debatable, as urinary catheterisation may cause complications. The aim of this study was to describe the incidence of re-catheterisa-tion and urologic complications during the initial 30 days following THA and TKA fast-track surgery.

METHODS: We conducted a prospective, observational study of 795 patients ≥ 50 years of age who had undergone elective fast-track THA or TKA with perioperative indwelling urinary catheterisation until the first post-operative morning. Primary outcomes were number of patients keeping their catheter the first post-operative morning and the incidence of re-catheterisations before discharge. Follow-up on post-discharge complications was done by phone 30 days after surgery.

RESULTS: A total of 784 of 795 included patients (98.6%) were analysed for the primary outcomes, and follow-up data were available for 760 patients (95.6%). Three patients (0.4%) kept their catheter after the first post-operative morning and 25 patients (3.2%) were re-catheterised before discharge. The median length of stay was two days (interquartile range: 1-2). The incidence of post-operative urinary tract infections (UTI) was 4.2%, and about 30% of the patients experienced pre-to-post-operative aggravation of their lower urinary tract symptoms.

CONCLUSIONS: Routine use of perioperative indwelling urinary catheterisation in fast-track THA and TKA may increase the risk of post-operative UTI and does not eliminate the need for subsequent re-catheterisation. These findings speak against routine use of perioperative indwelling catheterisation.

FUNDING: The study was supported by the Lundbeck Foundation and registered with clinicaltrials.gov.

TRIAL REGISTRATION: clinicaltrials.gov 8 April 2014 (NCT02133768).