The Joint EBJIS-MSIS 2026 Conference

General Versus Neuraxial Anesthesia and Infection Risk in Total Knee and Hip Arthroplasty: A Systematic Review and Meta-Analysis
Kyle Cantave, BA1; Reginald Chinweze M.D., LLM2; Andrew Cole Ringo Foster, BS1; David Dallas-Orr, MD, MBA, MTM2; Zachary Lum, DO2

1. University of California Davis, School of Medicine, Sacramento, CA, USA
2. Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA

Introduction

▪Surgical site infection (SSI) and periprosthetic joint infection (PJI) are debilitating complications of TKA and THA.

▪General anesthesia (GA) has been implicated as a risk factor for SSI/PJI.

▪Objective: to examine the association between anesthesia type and the risk of SSI and PJI on patients undergoing TKA and THA.

Methods

▪PRISMA-guided systematic review and meta-analysis.

▪Comparative studies of adult THA/TKA patients receiving GA vs. neuraxial anesthesia, reporting SSI and/or PJI.

Results

▪25 studies met inclusion criteria (24 SSI datasets; 3 PJI datasets).

▪SSI: directionally higher, statistically non-significant odds with GA; substantial heterogeneity.

▪PJI: no significant difference between anesthesia types; negligible heterogeneity.

Discussion

▪No significant infection difference: GA showed higher SSI odds than neuraxial, but not statistically significant.

▪ PJI data too sparse for firm conclusions.

▪High heterogeneity limits certainty: Inconsistent SSI/PJI definitions, short follow-up (30–90 days), and confounding by indication (GA often used in higher-risk patients) weaken the signal.

▪Implications: Anesthetic choice should stay individualized, not infection-driven.

▪Future studies need standardized endpoints, longer follow-up, and better confounder adjustment.

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The Joint EBJIS-MSIS 2026 Conference

Spinal vs General Anesthesia on the Risk of Surgical Site and Periprosthetic Joint Infections: A Systematic Review and Meta Analysis

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