Spinal anaesthesia may reduce complications after Total Joint Arthroplasty

US: Total joint arthroplasty (TJA) is a highly successful treatment for the management of advanced osteoarthritis (OA) in both hips and knees. Management of both the psychologic and physiologic aspects of pain associated with this surgical operation is a cooperative endeavour between the orthopaedic surgeon, patient, and anaesthetists.

A group of scientists at the American College of Surgeons have found that patients who underwent Total joint arthroplasty with Spinal anaesthesia experienced fewer 30-day complications.They had conducted a study comparing total knee arthroplasty (TKA) and total hip arthroplasty in spinal anaesthesia (SA) versus general anaesthesia (GA). This study was published in the Journal of American Academy of Orthopaedics.

The following three components were compared in the study-

• mortality,

• major and minor complication rates, and

• discharge disposition

Patients who underwent THA from January 1, 2011, to December 31, 2016, were identified that yielded a total of 131,427 patients. Patients who did not undergo either SA or GA, such as those receiving local anaesthesia, monitored anaesthesia care, and epidural anaesthesia (EA) were excluded. Patients were also excluded if their case was nonelective, which left a total of 110,963 eligible cases. Of these eligible cases, 45,871 patients underwent SA, whereas 65,092 patients underwent GA. The postoperative diagnosis was predominantly OA in both the SA and GA cohorts. Patients with SA had worse American Society of Anesthesiologist (ASA) classifications than GA patients for THA and patients with SA had a clinically irrelevant, statistically significant lower body mass index (BMI) of 0.6 kg/m2 for THA.

A similar process was then repeated for TKA patients from January 1, 2011, to December 31, 2016, which yielded 209,664 patients. After similar exclusion, a total of 183,080 eligible cases were identified. Of the 183,080 eligible cases, 80,077 patients underwent SA, whereas 103,003 patients underwent GA. In the TKA cohort, the postoperative diagnosis was again predominantly OA in both the SA and GA cohorts. SA patients had worse ASA classifications than GA patients for THA. In addition, SA patients had a clinically irrelevant but statistically significant lower BMI of 0.9 kg/m2 for TKA.

The key findings of the study were:

1)Patients who underwent TJA with SA experienced fewer 30-day complications.

2)They were less likely to have a nonhome discharge than those with GA.

To provide a comprehensive risk-benefit analysis regarding the selection of anaesthesia modality during TJA, providers should include a discussion of the increased risk of 30-day complications with GA.

For further reading click on the following link,

https://journals.lww.com/jaaos/Abstract/2020/03010/Spinal_Anesthesia_Is_Associated_With_Decreased.12.aspx