Anesthesia for Joint Replacement Surgery

Regional anesthesia poses fewer risks

When getting a joint (hip or knee) replacement, you may be given the choice between general anesthesia and regional anesthesia. The best type of anesthesia for you depends on your case, and your doctor may have good reasons to use one over the other.

While being completely under for such a procedure may seem more appropriate for a surgery as significant as this, in overall terms, a growing body of research shows that regional anesthesia may be the safer, cheaper, and more effective choice.

Doctor holding hip replacement implant
Peter Dazeley / Getty Images

Differences Between General and Regional Anesthesia

General anesthesia completely sedates a patient (puts them to sleep), using a ventilator machine to aid breathing. This is anesthesia in the classic sense and what most people think of when discussing surgery.

Regional anesthesia in joint replacement usually involves an epidural injection in the lower back that numbs the lower extremities (also called neuraxial or spinal anesthesia). This is the same anesthesia given to some women during childbirth.

Regional anesthesia also allows a patient to adjust their level of sedation during a surgical procedure, depending on their comfort. They can breathe without the aid of a machine during their procedure.

Regional anesthesia is not the same as local anesthesia. A "local" numbs only a small area for minor procedures (like stitches, for example). A regional numbs a much larger area for major procedures.

Why Regional Anesthesia Is Often Better

A number of studies have looked into different risks of joint replacement and how anesthetic choice influences the chances of complications. Regional anesthesia has consistently shown better outcomes than general anesthesia across a range of areas:

  • Lower 30-day post-operative mortality rate
  • Fewer medical complications (pulmonary/breathing problems in particular)
  • Lower infection rates
  • Less blood loss
  • Less need for post-operative pain medications like opioids (Epidurals take longer to wear off than general anesthesia, so patients can begin pain meds later.)
  • Shorter operating room procedure time
  • Shorter hospital stays: One study of nearly 11,000 joint replacement patients found regional anesthesia patients spend a full day less in the hospital (5.7 days versus 6.6 for general anesthesia).

All of this adds up to lower surgical risks, shorter recovery times, and lower overall medical costs.

When General Anesthesia May Be Needed

Despite the reasons to consider regional anesthesia, there may be times when general anesthesia is either favored by a patient or doctor, or medically necessary:

  • Medical conditions: General anesthesia may be preferable for someone who's had significant spinal surgery such as a lumbar fusion, which can make regional anesthesia more difficult. Spinal deformities, including scoliosis, may also make regional anesthesia more challenging. Also, medical conditions such as aortic stenosis make general anesthesia a safer option.
  • Patient anxiety: Many patients who choose general anesthesia do so because they simply understand that option better than regional anesthesia. They could also be anxious about having a spinal injection. If you have questions, speak with your doctor to learn more about how regional anesthesia is administered and the effects it can have.

A Word From Verywell

Every patient should discuss their particular circumstances with their surgeon and anesthesiologist to see which option is best for them. This discussion should also include what to expect the day of surgery and during recovery, as well as any aspects not fully understood. If needed, a second opinion may be useful to better understand the options.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Donauer K, Bomberg H, Wagenpfeil S, Volk T, Meissner W, Wolf A. Regional vs. general anesthesia for total knee and hip replacement: an analysis of postoperative pain perception from the international PAIN OUT Registry. Pain Pract. 2018;18(8):1036-1047. doi:10.1111/papr.12708

  2. Perlas A, Chan VW, Beattie S. Anesthesia technique and mortality after total hip or knee arthroplasty: a retrospective, propensity score-matched cohort study. Anesthesiology. 2016;125(4):724-31. doi:10.1097/ALN.0000000000001248

  3. Memtsoudis SG, Cozowicz C, Bekeris J, et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth. 2019;123(3):269-287. doi:10.1016/j.bja.2019.05.042

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.