The Role of Intraoperative Urinary Catheters on Postoperative Urinary Retention after Total Joint Arthroplasty: A Multi-Hospital Retrospective Study on 9,580 Patients

Document Type : RESEARCH PAPER


1 Department of Orthopedics, South Bay Medical Center, Kaiser Permanente Southern California Medical Group, Harbor City, CA, USA- 2196 Gaston Street, Winston-Salem, NC, USA

2 Department of Urology, South Bay Medical Center, Kaiser Permanente Southern California Medical Group, Harbor City, CA, USA

3 Department of Orthopedics, San Diego Medical Center, Kaiser Permanente Southern California Medical Group, San Diego, CA, USA

4 Department of Orthopedics, South Bay Medical Center, Kaiser Permanente Southern California Medical Group, Harbor City, CA, USA


Background: Urinary catheters (UC) are used by some surgeons during total joint arthroplasty (TJA). This study
investigated the impact of intraoperative urinary catheters on postoperative urinary retention (POUR) following TJA
Methods: We conducted a retrospective comparative study across 11 medical centers on 9,580 TJA patients. Visits
to urgent care or the emergency department within 7 and 30 postoperative days were reviewed. Medical records
over a 12-month period for all patients older than 18 years old were used to gather demographic and surgical
data as well as the incidence of urinary tract infection (UTI). Chi-squared tests (RStudio) were used to determine
statistical significance against P-Values (P) < 0.05.
Results: 13 (0.14%) patients returned within 7 days for POUR. POUR was more common in males [10 (0.3%) vs.
3 (0.1%) females, (P = 0.01)]. There was no difference in POUR when comparing total hip and knee arthroplasty
procedures [0.16% vs. 0.12%, (P = 0.60)]. Of all operations, 25% had intraoperative UC use. There was no difference
in POUR between the UC and no UC groups [0.21 vs. 0.11%, (P = 0.26)]. However, there was an increase in UTI
in UC vs. no UC use within 7 postoperative days [0.92 vs. 0.43%, (P = 0.005)] and 30 postoperative days [2.60 vs.
1.50 %, (P < 0.001)].
Conclusion: In our study, there was no difference in POUR rates between the intraoperative UC vs. no UC groups.
Therefore, the use of intraoperative UC may not decrease the rate of POUR following TJA procedures. Additionally,
UTI risk was higher in the UC group which may be attributable to other factors, especially when comparing female
vs. male patients.
Level of evidence: II


1. Kemp D, Tabaka N. Postoperative urinary retention:
Part II. A retrospective study. J Post Anesth Nurs.
2. Oishi CS, Williams VJ, Hanson PB, Schneider JE, Colwell
Jr CW, Walker RH. Perioperative bladder management
after primary total hip arthroplasty. J Arthroplasty.
3. Lampe HI, Sneller ZW, Rijnberg WJ. Urination
problems following total hip arthroplasty: insertion
or not of an indwelling catheter [in Dutch]? Ned
Tijdschr Geneeskd. 1992;136(17):827-831.
4. Michelson JD, Lotke PA, Steinberg ME. Urinarybladder
management after total joint replacement
surgery. N Engl J Med. 1988;319(6):321-326
5. Redfern TR, Machin DG, Parsons KF, Owen R. Urinary
retention in men after total hip arthroplasty. J Bone
Joint Surg Am. 1986;68(9):1435-1438.
6. Griesdale DE, Neufeld J, Dhillon D, Joo J, Sandhu S,
Swinton F, et al. Risk factors for urinary retention
after hip or knee replacement: a cohort study. Can J
Anaesth. 2011;58(12):1097-1104.
7. Wynd CA, Wallace M, Smith KM. Factors influencing
postoperative urinary retention following orthopaedic
surgical procedures. Orthop Nurs. 1996;15(1):43-50.
8. Waterhouse N, Beaumont AR, Murray K, Staniforth
P, Stone MH. Urinary retention after total hip
replacement: a prospective study. J Bone Joint Surg Br.
9. Williams A, Price N, Willett K. Epidural anaesthesia
and urinary dysfunction: the risks in total hip
replacement. J R Soc Med. 1995;88(12):699-701
10. Sarasin SM, Walton MJ, Singh HP, Clark DI. Can a
urinary tract symptom score predict the development
of postoperative urinary retention in patients
undergoing lower limb arthroplasty under spinal
anaesthesia? A prospective study. Ann R Coll Surg
Engl. 2006;88(4):394-398.
11. Karason S, Olafsson TA. Avoiding bladder
catheterisation in total knee arthroplasty: patient
selection criteria and low-dose spinal anaesthesia.
Acta Anaesthesiol Scand. 2013;57(5):639-645.
12. Huang ZY, Ma J, Shen B, Pei F. General Anesthesia:
To catheterize or Not? A Prospective Randomized
Controlled Study of Patients Undergoing Total Knee
Arthroplasty. J Arthroplasty. 2015;30(3):502–506.
13. Meddings J, Skolarus TA, Fowler KE, Bernstein
SJ, Dimick JB, Mann JD. Michigan Appropriate
Perioperative (MAP) criteria for urinary catheter use
in common general and orthopaedic surgeries: results
obtained using the RAND/UCLA Appropriateness
Method. BMJ Qual Saf. 2019;28:56–66.
14. Crain N, Tejirian T. Impact of Intraoperative
Foley Catheters on Postoperative Urinary
Retention after Inguinal Hernia Surgery. Am Surg.
15. Peel TN, Cheng AC, Liew D, Buising KL, Lisik J, Carroll
KA. Direct hospital cost determinants following hip
and knee arthroplasty. Arthritis Care Res (Hoboken).
16. Hollman F, Wolterbeek N, Veen R. Risk Factors
for Postoperative Urinary Retention in Men
Undergoing Total Hip Arthroplasty. Orthopedics.
17. Aiyer SN, Kumar A, Shetty AP, Kanna RM, Rajasekaran
S. Factors Influencing Postoperative Urinary
Retention Following Elective Posterior Lumbar
Spine Surgery: A Prospective Study. Asian Spine J.
18. Bjerregaard LS, Bogø S, Raaschou S, Troldborg C,
Hornum U, Poulsen AM. Incidence of and risk factors
for postoperative urinary retention in fast-track hip and
knee arthroplasty. Acta Orthop. 2015;86(2):183-188.
19. Kieffer WK, Kane TP. Predicting postoperative urinary
retention after lower limb arthroplasty. Ann R Coll
Surg Engl. 2012;94(5):356-358.
20. Rana S, Woolson ST, Giori NJ. History of Nocturia
May Guide Urinary Catheterization for Total Joint
Arthroplasty. Orthopedics. 2016;39(4):749-752.
21. Halawi MJ, Caminiti N, Cote MP, Lindsay AD, Williams
VJ. The Most Significant Risk Factors for Urinary
Retention in Fast-track Total Joint Arthroplasty are
Iatrogenic. J Arthroplasty. 2019;34(1):136-139.
22. Scholten R, Kremers K, van de Groes SAW, Somford DM,
Koëter S. Incidence and Risk Factors of Postoperative
Urinary Retention and Bladder Catheterization
in Patients Undergoing Fast-Track Total Joint
Arthroplasty: A Prospective Observational Study on
371 Patients. J Arthroplasty. 2018;33(5):1546-1551.
23. Knight RM, Pellegrini Jr VD. Bladder management
after total joint arthroplasty. J Arthroplasty. 1996;
24. Fernandez MA, Karthikeyan S, Wyse M, Foguet P.
The incidence of postoperative urinary retention in
patients undergoing elective hip and knee arthroplasty.
Ann R Coll Surg Engl. 2014;96(6):462-465.
25. Izard JP, Sowery RD, Jaeger MT, Siemens DR. Parameters
affecting urologic complications after major joint
replacement surgery. Can J Urol. 2006;13(3):3158-63.
26. McQueen DA, Kelly HK, Wright TF. A comparison of
epidural and non-epidural anesthesia and analgesia
in total hip or knee arthroplasty. Orthopedics.
27. Kinmont JC. Penetrating bladder injury caused by
a medially placed acetabular screw. J South Orthop
Assoc. 1999;8(2):98-100.
28. O’Sullivan AW, O’Malley KJ, Fitzpatrick JM, Smith JS.
Migration of prosthetic acetabulum into the bladder.
J Urol. 2001;166:617.
Volume 9, Issue 5
September and October 2021
Pages 480-486
  • Receive Date: 03 June 2020
  • Revise Date: 09 November 2020
  • Accept Date: 02 December 2020