General versus Neuraxial Anesthesia in Revision Surgery for Periprosthetic Joint Infection

Published:January 08, 2022DOI:



      The purpose of this study was to compare neuraxial and general anesthesia in revision surgery for periprosthetic joint infection (PJI).


      Patients undergoing revision arthroplasty for PJI were identified in the 2005-2019 American College of Surgeons National Surgical Quality Improvement Program databases. Thirty-day outcomes were compared between general and neuraxial anesthesia. Propensity-score matching and multivariate analysis were used to control for patient and procedural variables.


      Neuraxial anesthesia was used in 1,511 (16.8%) cases and general anesthesia in 7,468 (83.2%) cases. Neuraxial anesthesia had a lower risk of any adverse event (odds ratio [OR] 0.70, p<0.001), serious adverse events (OR 0.77, p<0.001), and minor adverse events (OR 0.66, p<0.001). Among 875 reoperations and 1,351 readmissions, two had a diagnosis of intraspinal abscess, both occurring after general anesthesia.


      Neuraxial anesthesia was associated with a lower risk of adverse events when compared to general anesthesia in revision surgery for PJI.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Warren J.
        • Sundaram K.
        • Anis H.
        • Kamath A.F.
        • Mont M.A.
        • Higuera C.A.
        • Piuzzi N.S.
        Spinal Anesthesia Is Associated With Decreased Complications After Total Knee and Hip Arthroplasty.
        J Am Acad Orthop Surg. 2020; 28: e213
        • Pugely A.J.
        • Martin C.T.
        • Gao Y.
        • Mendoza-Lattes S.
        • Callaghan J.J.
        Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty.
        J Bone Joint Surg Am. 2013; 95: 193
        • Basques B.A.
        • Toy J.O.
        • Bohl D.D.
        • Golinvaux N.S.
        • Grauer J.N.
        General compared with spinal anesthesia for total hip arthroplasty.
        J Bone Joint Surg Am. 2015; 97: 455
        • Memtsoudis S.G.
        • Sun X.
        • Chiu Y.L.
        • Stundner O.
        • Liu S.S.
        • Banerjee S.
        • Mazumdar M.
        • Sharrock N.E.
        Perioperative comparative effectiveness of anesthetic technique in orthopedic patients.
        Anesthesiology. 2013; 118: 1046
        • Chaturvedi R.
        • Burton B.N.
        • Gabriel R.A.
        Complication Rates and the Benefits of Neuraxial Anesthesia in the Patient With High Comorbidity Burden Undergoing Primary Total Joint Arthroplasty.
        J Arthroplasty. 2020; 35: 3089
        • Wilson J.M.
        • Farley K.X.
        • Bradbury T.L.
        • Guild G.N.
        Is Spinal Anesthesia Safer than General Anesthesia for Patients Undergoing Revision THA? Analysis of the ACS-NSQIP Database.
        Clin Orthop Relat Res. 2020; 478: 80
        • Wilson J.M.
        • Farley K.X.
        • Erens G.A.
        • Guild 3rd, G.N.
        General vs Spinal Anesthesia for Revision Total Knee Arthroplasty: Do Complication Rates Differ?.
        J Arthroplasty. 2019; 34: 1417
        • Parvizi J.
        • Rasouli M.R.
        General compared with neuraxial anesthesia for total hip and knee arthroplasty.
        Ann Transl Med. 2015; 3: 318
        • Chang C.C.
        • Lin H.C.
        • Lin H.W.
        • Lin H.C.
        Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study.
        Anesthesiology. 2010; 113: 279
        • Buggy D.J.
        • Doherty W.L.
        • Hart E.M.
        • Pallett E.J.
        Postoperative wound oxygen tension with epidural or intravenous analgesia: a prospective, randomized, single-blind clinical trial.
        Anesthesiology. 2002; 97: 952
        • Bohl D.D.
        • Ondeck N.T.
        • Darrith B.
        • Hannon C.P.
        • Fillingham Y.A.
        • Della Valle C.J.
        Impact of Operative Time on Adverse Events Following Primary Total Joint Arthroplasty.
        J Arthroplasty. 2018; 33: 2256
        • Agarwal A.
        • Kishore K.
        Complications and controversies of regional anaesthesia: a review.
        Indian J Anaesth. 2009; 53: 543
        • Grewal S.
        • Hocking G.
        • Wildsmith J.A.W.
        Epidural abscesses.
        British Journal of Anaesthesia. 2006; 96: 292
        • Gritsenko K.
        • Marcello D.
        • Liguori G.A.
        • Jules-Elysée K.
        • Memtsoudis S.G.
        Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses.
        BJA: British Journal of Anaesthesia. 2011; 108: 485
        • Berman R.S.
        • Eisele J.H.
        Bacteremia, spinal anesthesia, and development of meningitis.
        Anesthesiology. 1978; 48: 376
        • Wedel D.
        • Horlocker T.
        Regional Anesthesia in the Febrile or Infected Patient.
        Regional Anesthesia and Pain Medicine. 2006; 31: 324
        • Rasouli M.R.
        • Cavanaugh P.K.
        • Restrepo C.
        • Ceylan H.H.
        • Maltenfort M.G.
        • Viscusi E.R.
        • Parvizi J.
        Is neuraxial anesthesia safe in patients undergoing surgery for treatment of periprosthetic joint infection?.
        Clin Orthop Relat Res. 2015; 473: 1472
        • Boddapati V.
        • Fu M.C.
        • Mayman D.J.
        • Su E.P.
        • Sculco P.K.
        • McLawhorn A.S.
        Revision Total Knee Arthroplasty for Periprosthetic Joint Infection Is Associated With Increased Postoperative Morbidity and Mortality Relative to Noninfectious Revisions.
        J Arthroplasty. 2018; 33: 521
        • Schwartz A.M.
        • Farley K.X.
        • Guild G.N.
        • Bradbury T.L.
        Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030.
        The Journal of Arthroplasty. 2020; 35: S79
      1. American College of Surgeons. User Guide for the 2019 ACS NSQIP Participant Use Data File. 2020. Accessed 2021 June 1. In.:

        • Jella T.K.
        • Acuña A.J.
        • Samuel L.T.
        • Schwarzkopf R.
        • Fehring T.K.
        • Kamath A.F.
        Medicare Physician Fee Reimbursement for Revision Total Knee Arthroplasty Has Not Kept Up with Inflation from 2002 to 2019.
        J Bone Joint Surg Am. 2021; 103: 778
        • Rosero E.B.
        • Joshi G.P.
        Nationwide incidence of serious complications of epidural analgesia in the United States.
        Acta Anaesthesiologica Scandinavica. 2016; 60: 810
      2. Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques.
        Anesthesiology. 2017; 126: 585