Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 7;104(17):1542-1547.
doi: 10.2106/JBJS.22.00280. Epub 2022 Jun 17.

Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties

Aaron R Owen  1 , Adam W Amundson  2 , Kristin M Fruth  3 , Christopher M Duncan  2 , Hugh M Smith  2 , Rebecca L Johnson  2 , Michael J Taunton  1 , Mark W Pagnano  1 , Daniel J Berry  1 , Matthew P Abdel  1
Affiliations

Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties

Aaron R Owen et al. J Bone Joint Surg Am. .

Abstract

Background: The specific advantages of spinal anesthesia compared with general anesthesia for primary total hip arthroplasty (THA) remains unknown. Therefore, this study aimed to investigate the pain control, length of stay, and postoperative outcomes associated with spinal anesthesia compared with general anesthesia in a large cohort of primary THAs from a single, high-volume academic institution.

Methods: We retrospectively identified 13,730 primary THAs (11,319 patients) from 2001 to 2016 using our total joint registry. Of these cases, 58% had general anesthesia and 42% had spinal anesthesia. The demographic characteristics were similar between groups, with mean age of 64 years, 51% female, and mean body mass index (BMI) of 31 kg/m 2 . Data were analyzed using an inverse probability of treatment weighted model based on a propensity score that accounted for numerous patient and operative factors. The mean follow-up was 6 years.

Results: Patients treated with spinal anesthesia had lower Numeric Pain Rating Scale (NPRS) scores (p < 0.001) and required fewer postoperative oral morphine equivalents (OMEs) at all time points evaluated (p < 0.001). Patients treated with spinal anesthesia also had shorter hospital length of stay (p = 0.02), fewer altered mental status events (odds ratio [OR], 0.7; p = 0.02), and fewer intensive care unit (ICU) admissions (OR, 0.7; p = 0.01). There was no difference in the incidence of deep vein thrombosis (p = 0.8), pulmonary embolism (p = 0.4), 30-day readmissions (p = 0.17), 90-day readmissions (p = 0.18), all-cause revisions (p = 0.17), or all-cause reoperations (p = 0.14).

Conclusions: In this large, single-institution study, we found that spinal anesthesia was associated with reduced pain scores and OME use postoperatively. Furthermore, spinal anesthesia resulted in fewer altered mental status events and ICU admissions. These data favor the use of spinal anesthesia in primary THAs.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H95 ).

Similar articles

See all similar articles

Cited by

References

    1. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007 Oct 27;370(9597):1508-19.
    1. Sun C, Zhang Y, Li LT, Ding H, Guo T, Zhao JN. Long-term outcomes of total hip arthroplasty with transverse subtrochanteric shortening osteotomy and modular stem in Crowe IV developmental dysplasia. J Arthroplasty. 2021 Feb;36(2):630-5.
    1. Hart A, Janz V, Trousdale RT, Sierra RJ, Berry DJ, Abdel MP. Long-term survivorship of total hip arthroplasty with highly cross-linked polyethylene for osteonecrosis. J Bone Joint Surg Am. 2019 Sep 4;101(17):1563-8.
    1. Ollivier M, Abdel MP, Krych AJ, Trousdale RT, Berry DJ. Long-term results of total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe IV developmental dysplasia. J Arthroplasty. 2016 Aug;31(8):1756-60.
    1. Bukowski BR, Clark NJ, Taunton MJ, Freedman BA, Berry DJ, Abdel MP. Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty. 2021 Jul;36(7S):S282-9.