Incesoy Mustafa Alper, Demırkıran Cemil Burak, Aliyev Orkhan, Pulatkan Anil, Yabaci Tak Aysegul, Yesıltas Serdar, Tuncay Ibrahim, Yıldız Fatih
Department of Orthopedics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Türkiye.
Rotkreuzklinik Wertheim, Department of Orthopaedics and Traumatology, Wertheim, Germany.
Acta Orthop Traumatol Turc. 2025 May 28;59(3):152-155. doi: 10.5152/j.aott.2025.24091.
Objective: This study aimed to evaluate the impact of spinal anesthesia (SA) compared to general anesthesia (GA) on clinical outcomes in patients undergoing direct anterior approach total hip arthroplasty (DAA-THA) at a single institution. Methods: This prospective observational study was conducted at a single institution between 2014 and 2017. A total of 437 patients who underwent primary elective DAA-THA were included. Among them, 363 patients received SA, and 74 patients received GA. Demographic characteristics (age, sex), comorbidities, American Society of Anesthesiologists (ASA) scores, and preoperative hematocrit levels were recorded. The mean age was 59.4 years (range, 26-82 years), and 67.3% of the patients were female. The primary outcome measures included complication rates, estimated blood loss (EBL), changes in hematocrit, length of hospital stay (LOS), duration of surgery, acetabular and femoral component orientation, and stem subsidence. Results: No significant differences were found between the GA and SA groups regarding median EBL (0.9 L vs. 0.9 L, P=.675), hematocrit change (-8.12% vs. -7.70%, P=.727), mean duration of surgery (103 min vs. 105 min, P=.999), and LOS (3.5 days vs. 3.6 days, P=.462). Radiological outcomes, including femoral stem varus/valgus alignment (0.2° vs. 0.3°, P=.877), stem subsidence (0.9 mm vs. 1.0 mm, P=.111), and acetabular component abduction angles (42° vs. 43°, P=.475), were also comparable. The overall complication rates were 8% in the GA group and 5% in the SA group (P=.400). Conclusion: Both general and spinal anesthesia can be safely utilized in DAA-THA, providing comparable clinical and radiological outcomes. The choice of anesthesia did not significantly affect surgical time, blood loss, or complication rates. These findings are clinically relevant for optimizing anesthesia strategies in DAA-THA, offering flexibility for both surgeons and anesthesiologists without compromising patient outcomes. Level of Evidence: Level II, Therapeutic Study.
本研究旨在评估在单一机构中，与全身麻醉（GA）相比，脊髓麻醉（SA）对接受直接前路全髋关节置换术（DAA-THA）患者临床结局的影响。方法：本前瞻性观察性研究于2014年至2017年在单一机构进行。共纳入437例行初次择期DAA-THA的患者。其中，363例患者接受SA，74例患者接受GA。记录人口统计学特征（年龄、性别）、合并症、美国麻醉医师协会（ASA）评分和术前血细胞比容水平。平均年龄为59.4岁（范围26-82岁），67.3%的患者为女性。主要结局指标包括并发症发生率、估计失血量（EBL）、血细胞比容变化、住院时间（LOS）、手术时长、髋臼和股骨组件的方向以及假体柄下沉情况。结果：GA组和SA组在中位EBL（0.9L对0.9L，P = 0.675）、血细胞比容变化（-8.12%对-7.70%，P = 0.727）、平均手术时长（103分钟对105分钟，P = 0.999）和LOS（3.5天对3.6天，P = 0.462）方面未发现显著差异。包括股骨柄内翻/外翻对线（0.2°对0.3°，P = 0.877）、假体柄下沉（0.9mm对1.0mm，P = 0.111）和髋臼组件外展角度（42°对43°，P = 0.475）在内的影像学结局也具有可比性。GA组的总体并发症发生率为8%，SA组为5%（P = 0.400）。结论：全身麻醉和脊髓麻醉均可安全用于DAA-THA，提供相似的临床和影像学结局。麻醉方式的选择对手术时间、失血量或并发症发生率没有显著影响。这些发现对于优化DAA-THA的麻醉策略具有临床意义，为外科医生和麻醉医生提供了灵活性，同时不影响患者结局。证据级别：二级，治疗性研究。
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