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Hip and Knee Replacement Outcomes Better when Surgeons Use Regional Anesthesia

People undergoing total hip or total knee replacement surgeries are at a lower risk for complications if they have regional, versus general, anesthesia, according to a new study.

While it’s not as commonly used as general anesthesia during joint replacement surgery, neuraxial anesthesia, also known as spinal or epidural anesthesia, involves injecting medication into fatty tissue that surrounds the nerve roots in the spine (known as an epidural) or into the cerebrospinal fluid that surrounds the spinal cord.

Researchers at the Hospital for Special Surgery published their findings in the May 2013 issue of the scientific journal Anesthesiology. They found that total joint replacement patients who had neuraxial anesthesia during surgery were less likely than those who had general anesthesia to have complications or die. Hospital stays and costs were also reduced by using the regional, versus the general, anesthesia option.

The researchers reviewed hip and knee replacement surgery records between 2006 and 2010 from approximately 400 U.S. acute care hospitals. Only 11 percent of the patients in this database were documented to have had neuraxial anesthesia, 14.2% received combined neuraxial and general anesthesia, and 74.8% received general anesthesia.

Death within 30 days was notably higher in general anesthesia patients, when compared to the other two groups. Complications, such as kidney failure, were also higher in the general anesthesia group, compared to the others. Costs were lowest in the neuraxial anesthesia group.

Dr. Stavros Memtsoudis, director of critical care services at Hospital for Special Surgery, New York City, points out that educating patients is key.

“Some patients don’t like the idea of having an injection in their back and their legs being numb, but a thorough discussion of risks, benefits and alternatives can go a long way to help an educated patient make rational decisions,” he says. “For the anesthesiologist, a number of factors come into play, including patient comorbidities and preferences as well as other practice specific factors, such as the choice for anticoagulation, but regional anesthesia should, at the very least, be considered in every patient.”

Physical therapy can help people prevent or delay the need for total joint replacement surgery, as well as improve total joint replacement surgery results by maximizing patients’ mobility, flexibility, strength and function. For more information about physical therapy before and after hip or knee joint replacement surgery, contact A Physical Therapist, Inc.

A Physical Therapist, Inc., is a one-on-one physical therapy clinic in Delray Beach, Fla., and Harrisburg, Penn. For patients in Palm Beach County, A Physical Therapist, Inc., is easily accessible from Boca Raton or Boynton Beach. For patients in Dauphin County, A Physical Therapist, Inc., is easily accessible from Hershey and Marysville.

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