Spinal Anesthesia Can Be Appropriate in B2 Periprosthetic Fracture Surgery

Periprosthetic fractures (PPFx) after total hip arthroplasty, especially Vancouver B2 fractures, are associated with high morbidity and mortality. Anesthesia type may influence early postoperative outcomes, yet limited data exist comparing spinal versus general anesthesia in this population.

A retrospective review of 165 PPFx cases from January 1, 2019, to June 30, 2024, at a high-volume orthopaedic specialty hospital identified 95 patients with Vancouver B2 PPFx. Patients were grouped by anesthesia type: spinal (40) or general (55). Demographics, perioperative characteristics, and 30-day outcomes were analyzed. Statistical analysis included chi-squared tests, t-tests, and regression modeling.

Patients receiving general anesthesia had significantly higher American Society of Anesthesiologists scores (3.1 vs. 2.8; P = 0.008) and Charlson Comorbidity Index scores (5.4 vs. 4.0; P < 0.001). General anesthesia was associated with longer surgical time (+21 minutes, P = 0.029), longer postoperative acute care unit time (+25 minutes, P = 0.034), longer length of stay (+1.8 days, P = 0.024), and a higher transfusion rate (76.5% vs. 55.0%; P = 0.028). Pain scores, physical therapy performance, and complication rates were similar. One-year mortality was approximately 20% in both groups.

Spinal anesthesia is a safe and effective option for appropriately selected patients undergoing surgery for Vancouver B2 periprosthetic femoral fractures. Despite differences in some perioperative metrics (longer surgical time, postoperative acute care unit time, length of stay, and higher transfusion rates with general anesthesia), complication and mortality rates were equivalent between the two groups. This suggests that the choice of anesthesia should be individualized based on the patient's health status and the complexity of the surgery.