Spinal versus general anaesthesia in contemporary primary total knee arthroplasties

A. R. Owen, A. W. Amundson, D. R. Larson, C. M. Duncan, H. M. Smith, R. L. Johnson, M. J. Taunton, M. W. Pagnano, D. J. Berry, M. P. Abdel

Research output: Contribution to journalArticlepeer-review


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 th at 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 a naesthesia was associated with reduced risk of any revision and any reoperatio n after accounting for numerous patient and operative factors. When possible and safe, spinal anaesthesia should be considered in primary TKAs.

Original languageEnglish (US)
Pages (from-to)1209-1214
Number of pages6
JournalBone and Joint Journal
Issue number11
StatePublished - Nov 2022

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Spinal versus general anaesthesia in contemporary primary total knee arthroplasties'. Together they form a unique fingerprint.

Cite this