Comparison of spinal anesthesia and general anesthesia in total hip and total knee arthroplasty: a meta-analysis and systematic review.

Introduction: Explore whether general anesthesia or spinal anesthesia is more beneficial for patients undergoing total hip replacement and total knee replacement. Offer new clinical evidence to guide the selection of the optimal anesthesia solution for total hip replacement and total knee replacement.

Evidence acquisition: A systematic search was conducted in PubMed, Web of Science, Scopus and the Cochrane Library to find relevant studies from January 1^st, 2010 to November 31^st, 2024. Non-randomized, retrospective studies that reported mortality, postoperative pain, and other postoperative complications after comparing two anesthesia methods in total hip replacement and total knee replacement were included in this meta-analysis. Data were pooled using the risk ratio or standardized mean difference with 95% confidence interval. The fixed-effect model is used when the outcome heterogeneity is small, otherwise the random-effects model is used.

Evidence synthesis: A total of 41 retrospective studies were included, involving 2,291,587 patients. Results show that spinal anesthesia significantly reduces the risk of postoperative mortality (RR=1.17; 95% CI: 1.04 to 1.32; P=0.008) and other complications, shortens the length of hospital stay (SMD=0.18; 95% CI: 0.12 to 0.23; P<0.00001), and has better analgesic effects. And the GRADE evidence evaluation results show that the main outcomes have a certain recommendation strength.

Conclusions: In total hip replacement and total knee replacement, spinal anesthesia may be more beneficial to patients. Therefore, if contraindications to spinal anesthesia are excluded, spinal anesthesia should be used as much as possible, especially for some special populations, such as patients with poor basic conditions, based on our results, who should be more inclined to spinal anesthesia.