Editorial Commentary: Prosthetic Joint Replacement: Should Orthopedists Check Urine Because It's There?

Extract

(See the Major Article by Sousa et al on pages 41–7.)

Remote infection has long been considered a risk factor for prosthetic joint infection (PJI), a dreaded complication for orthopedic surgeons and patients who require joint replacement. Symptomatic urinary tract infection has been suspected as a cause of PJI in such patients, with little supportive evidence. There is concern that asymptomatic bacteriuria (ASB) could be another cause and that frail, elderly patients needing joint replacement might not express or manifest symptoms of urinary tract infection, placing them at untoward risk of PJI. Such concerns often lead surgeons to more vigilant screening.

Despite scant supporting evidence, preoperative screening with urinalysis and/or urine culture has been advocated to prevent ASB from causing PJI [1]. Noting lack of clarity on the issue, David and Vrahas [2] advocated 8–10 days of perioperative treatment of ASB. Preoperative treatment of ASB is common in some quarters, and is often considered a standard of care. Should it be?