The Journal of arthroplasty
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Randomized Controlled Trial Clinical Trial
Bladder management after total joint arthroplasty.
This study was undertaken to determine the impact of an indwelling Foley catheter on bladder dysfunction and incidence of urinary tract infections after total joint arthroplasty. A prospective randomized controlled trial was conducted assigning use of an indwelling Foley catheter (group 1) or intermittent catheterization (group 2) for 48 hours following operation. Postoperative cultures were obtained on days 2 and 5, and the number of intermittent catheterization events and void and catheterization volumes were recorded. ⋯ Bladder management by indwelling Foley catheter saved more than 150 minutes of direct nursing contact per patient and $3,000 in total hospital costs. Indwelling Foley catheters reduced the frequency of postoperative urinary retention, were less labor intensive than intermittent straight catheterization, and were not associated with an increased risk of urinary infection. In the setting of epidural anesthesia and postoperative analgesia for total joint arthroplasty, management by indwelling catheter is a cost-effective strategy to facilitate postoperative return of normal bladder function.
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The case of an active 53-year-old man with a well-functioning unicompartmental knee arthroplasty who suffered an acute athletic injury to the knee is described. A mechanical problem was diagnosed and he was successfully treated by arthroscopic partial lateral meniscectomy for a displaced meniscal tear. This case points to an important difference noted by history and physical examination between an acute injury to the unreplaced compartment of a knee with a unicompartmental knee arthroplasty and progression of the arthritic process.