Spinal versus general anaesthesia in contemporary primary total knee arthroplasties

Abstract

Aims Spinal anaesthesia has seen increased use in contemporary primary total knee arthroplasties (TKAs). However, controversy exists about the benefits of spinal in comparison to general anaesthesia in primary TKAs. This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anaesthesia in primary TKAs from a single, high-volume academic centre. Methods We retrospectively identified 17,690 primary TKAs (13,297 patients) from 2001 to 2016 using our institutional total joint registry, where 52% had general anaesthesia and 48% had spinal anaesthesia. Baseline characteristics were similar between cohorts with a mean age of 68 years (SD 10), 58% female (n = 7,669), and mean BMI of 32 kg/m2 (SD 7). Pain was evaluated using oral morphine equivalents (OMEs) and numerical pain rating scale (NPRS) data. Complications including 30- and 90-day readmissions were studied. Data were analyzed using an inverse probability of treatment weighted model based on propensity score that included many patient and surgical factors. Mean follow-up was seven years (2 to 18). Results Patients treated with spinal anaesthesia required fewer postoperative OMEs (p < 0.001) and had lower NPRS scores (p < 0.001). Spinal anaesthesia also had fewer cases of altered mental status (AMS; odds ratio (OR) 1.3; p = 0.044), as well as 30-day (OR 1.4; p < 0.001) and 90-day readmissions (OR 1.5; p < 0.001). General anaesthesia was associated with increased risk of any revision (OR 1.2; p = 0.021) and any reoperation (1.3; p < 0.001). Conclusion In the largest single institutional report to date, we found that spinal anaesthesia was associated with significantly lower OME use, lower risk of AMS, and lower overall 30- and 90-day readmissions following primary TKAs. Additionally, spinal anaesthesia was associated with reduced risk of any revision and any reoperation after accounting for numerous patient and operative factors. When possible and safe, spinal anaesthesia should be considered in primary TKAs. Cite this article: Bone Joint J 2022;104-B(11):1209–1214.

Spinal anaesthesia versus general anaesthesia (SAGA) on recovery after hip and knee arthroplasty: A study protocol for three randomized, single‐blinded, multi‐centre, clinical trials

“…Retrospective studies comparing SA to GA are generally favouring SA, reporting less use of opioids, lower post-operative pain, and fewer complications. 31 However, as mentioned in most of the studies, investigating this topic retrospectively across a period from 2000 to 2020 has some crucial limitations. In many countries a move towards SA over time results in more GA procedures to be from the early period (e.g., 2000-2010), while most SA procedures are from 2007 to 2010 and onwards.…”

“…In many countries a move towards SA over time results in more GA procedures to be from the early period (e.g., 2000-2010), while most SA procedures are from 2007 to 2010 and onwards. 31 This means that not only are most SA procedures performed using contemporary SA regimes, which are then compared to older GA regimes, but SA procedures were also more likely to be performed in mod- This study also has some limitations. First, a study of this size is not suitable for investigating the occurrence of rare, but important, complications.…”

“…Retrospective studies comparing SA to GA are generally favouring SA, reporting less use of opioids, lower post‐operative pain, and fewer complications 31 . However, as mentioned in most of the studies, investigating this topic retrospectively across a period from 2000 to 2020 has some crucial limitations.…”

Assessing ChatGPT Responses to Common Patient Questions Regarding Total Hip Arthroplasty

“…However, the chatbot provided little information regarding the exact incidence of each complication, instead describing them as rare or uncommon. Although such descriptions are generally true 39 , complication rates can vary according to numerous patient and surgical factors [40][41][42] , which the chatbot did not acknowledge. Additionally, the chatbot only suggested that revision may be required in cases of implant failure, whereas in actuality infection, dislocation, implant loosening, implant wear, and even nerve or blood-vessel injury could result in reoperation and/or revision.…”

Knee

“…This study is a retrospective review of patients who underwent primary total knee arthroplasty at the Mayo Clinic in Rochester (Minnesota, USA) from 2001 to 2016. 3 The study included 17,690 TKAs (13,297 patients) with 52% of receiving GA and 48% receiving spinal anaesthesia. The authors noted a difference in practice throughout the study period with an increasing use of spinal anaesthesia and a corresponding decrease in GA.…”