Last reviewed: September 29, 2026

Often spinal, when it suits your health. The evidence leans toward spinal, though most of it comes from hospital records rather than trials.

With general anesthesia, you are fully asleep. With a spinal, medicine injected in the lower back numbs you from the waist down.

Large record studies of hip replacements found fewer complications with spinal, including fewer breathing problems, heart problems and blood transfusions. Pooled studies found fewer deaths with spinal. But record studies cannot fully account for why one person was given a spinal and another was not.

Trials that assigned people at random are few and small. Pooled together, they found less nausea and a slightly shorter hospital stay with spinal. None was large enough to show whether one is safer.

For same-day hip replacement, no guideline recommends one type over the other. In a large study of same-day hip and knee replacements, serious complications were about equally rare with either, but people given a spinal had less pain and nausea and were more likely to go home that day. In one trial, a shorter-acting spinal got more people walking and home the same day.

A spinal has its own drawbacks. Trouble passing urine afterward is more common, and occasionally a spinal does not work well enough and general anesthesia is used instead.

An international group of anesthesia experts strongly recommends spinal for hip replacement, based on moderate- to low-quality evidence.

In general:

  • The choice is made with your anesthesiologist, based on your health.
  • If being awake during surgery worries you, ask about sedation.
  • Tell the anesthesia team about blood thinners, sleep apnea, lung disease or any past spine surgery.
  • Trouble passing urine after surgery is worth reporting.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

  • Memtsoudis SG, 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. https://doi.org/10.1016/j.bja.2019.05.042
  • Basques BA, et al. General Compared With Spinal Anesthesia for Total Hip Arthroplasty. J Bone Joint Surg Am. 2015. https://doi.org/10.2106/JBJS.N.00662
  • Harris AB, et al. Comparison of Pneumonia and Major Complications After Total Joint Arthroplasty With Spinal Versus General Anesthesia: A Propensity-Matched Cohort Analysis. J Am Acad Orthop Surg. 2024. https://doi.org/10.5435/JAAOS-D-23-00192
  • Johnson RL, et al. Neuraxial vs General Anaesthesia for Total Hip and Total Knee Arthroplasty: A Systematic Review of Comparative-Effectiveness Research. Br J Anaesth. 2016. https://doi.org/10.1093/bja/aev455
  • Pu X, et al. General Anesthesia vs Spinal Anesthesia for Patients Undergoing Total-Hip Arthroplasty: A Meta-Analysis. Medicine (Baltimore). 2019. https://doi.org/10.1097/MD.0000000000014925
  • Yap E, et al. Neuraxial and General Anesthesia for Outpatient Total Joint Arthroplasty Result in Similarly Low Rates of Major Perioperative Complications: A Multicentered Cohort Study. Reg Anesth Pain Med. 2022. https://doi.org/10.1136/rapm-2021-103189
  • Schwenk ES, et al. Mepivacaine Versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation. Anesthesiology. 2020. https://doi.org/10.1097/ALN.0000000000003480
  • Azarboo A, et al. Risk Factors of Postoperative Urinary Retention Following Total Hip and Knee Arthroplasty. Bone Jt Open. 2024. https://doi.org/10.1302/2633-1462.57.BJO-2024-0003.R1

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

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