Hip replacement, hip seeding, and epidural anaesthesia

A Macdowell and colleagues recently reported that epidural anaesthesia does not increase the need for urinary catheterisation after total hip arthroplasty compared with the situation in patients receiving general anaesthesia.

This observation in the UK is important as, for years, orthopedic surgeons and anaesthetists have been reluctant to use epidural anaesthesia, thinking that such anaesthesia increases the need for urinary catheterisation. Experience in the UK

had been that urinary catheterisation might result in bacterial seeding to the recently operated hip, with disastrous consequences because gram-negative infections are fairly resistant to treatment.