High Utilization of Neuraxial Anesthesia in Revision Total Joint Arthroplasty is Safe and Effective

Evidence in support of neuraxial anesthesia in revision total joint arthroplasty (rTJA) is still emerging. The purpose of this study was to demonstrate whether most rTJAs performed at an orthopaedic specialty hospital can be safely completed under neuraxial anesthesia.

A retrospective cohort study including all patients who underwent revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) between June 3, 2024, and September 17, 2025, at a single institution was performed. Patients were divided by method of anesthesia. The primary outcome was the rate of neuraxial anesthesia utilization. Secondary outcomes included differences in baseline demographics and outcomes between groups. Propensity score matching for neuraxial versus general anesthesia was performed. Univariate analyses were utilized to compare groups. A total of 500 patients underwent rTJA (273 rTKA, 227 rTHA) during the study period. For rTKA and rTHA patients, 219 (80.2%) and 133 (58.6%) received neuraxial anesthesia, respectively.

On matched analysis for rTKA, general anesthesia was associated with higher intraoperative (57.2 versus 21.6 mL, P < 0.001) and total (175.9 versus 119.6 mL, P < 0.001) morphine equivalents administered and readmissions (15.7 versus 1.1%, P = 0.002). For rTHA, general anesthesia was associated with a longer length of stay (83.0 versus 47.4 hours, P < 0.001), increased blood loss (610.0 versus 406.8 mL, P = 0.007), higher rates of transfusion (28.6 versus 11.4%, P = 0.02), and higher readmissions (18.6 versus 1.4%, P = 0.002). Total (144.9 versus 79.5 P < 0.001), intraoperative (59.8 versus 25.4, P < 0.001), and postoperative (85.0 versus 54.0, P = 0.002) morphine equivalents administered were higher in the THA general anesthesia group than the neuraxial anesthesia group.

This study suggests that neuraxial anesthesia is safe and effective in rTJA, including complex cases. Neuraxial anesthetic may be considered more routinely for rTJA.