Urinary Incontinence in Men and Women After Total Hip Arthroplasty: A Retrospective Observational Cohort Study

TL;DR

This study found that total hip arthroplasty leads to significant improvement in urinary incontinence for both men and women, regardless of sex or surgical approach.

Contribution

The study provides evidence that THA improves UI in older patients, independent of sex or surgical approach.

Findings

Patients with preoperative UI showed significant improvements in ICIQ-SF total, frequency, and severity scores after THA.

Sex, surgical approach, and type of UI had no significant effect on postoperative UI outcomes.

Only 9.6% of continent patients developed UI postoperatively.

Abstract

Background: Our understanding of improved urinary incontinence (UI) following total hip arthroplasty (THA) is incomplete. Accordingly, our aim was to investigate the association between THA (anterior and posterior approach) on UI (stress, urge, and mixed urge/stress) in older women and men presenting with UI prior to THA.

Methods: A retrospective review of 318 consecutive patients who underwent primary unilateral THA in an acute surgical hospital was undertaken. Pre- and postoperative continence status was assessed using the International Consultation of Incontinence Questionnaire Urinary Incontinence (ICIQ-UI) Short Form (ICIQ-SF).

Results: Of the 288 patients included in our study, 120 patients had preoperative UI (Incontinent Group) and 168 were continent preoperatively (Continent Group). Postoperatively, 101 patients in the Incontinent Group and 114 patients in the Continent Group completed the ICIQ-SF. Following THA, patients in the Incontinent Group had significant changes in ICIQ-SF total scores (MD=1.7; 95% CI=0.93-2.56; p<0.01), frequency scores (MD=0.7; 95% CI=0.46-0.94; p<0.01), and severity scores (MD=0.6; 95% CI=0.31-0.84; p<0.01) and a non-significant decrease in the ICIQ-SF quality of life scores (MD=0.5; 95% CI=-0.10-1.03; p<0.01). Patients' sex (p=0.94), THA surgical approach (p=0.62), and the type of UI (p=0.61) had no significant effect on postoperative ICIQ-SF total scores. There was a non-significant relationship between age (r=0.03; p=0.79) and time to postoperative follow-up visit (r=-0.11; p=0.27) with ICIQ-SF total scores. In the Continent Group, 11 patients (9.6%) had postoperative UI.

Conclusions: For women and men with UI prior to THA, there was a significant postoperative improvement in UI, independent of sex or surgical approach. Including UI assessment and clinical management strategies into the pre- and postoperative care of women and men undergoing THA procedures is indicated.

Figures