Cemil Burak Demirkıran

Objective: This study aimed to evaluate the impact of spinal anesthesia (SA) compared to general anesthesia (GA) on clinical outcomes inpatients 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 radiologicaloutcomes. The choice of anesthesia did not significantly affect surgical time, blood loss, or complication rates. These findings areclinically relevant for optimizing anesthesia strategies in DAA-THA, offering flexibility for both surgeons and anesthesiologists without compromising patient outcomes. Cite this article as: Incesoy MA, Demırkıran CB, Aliyev O, et al. Comparison of general and spinal anesthesia on outcomes of direct anterior approach total hiparthroplasty: a prospective observational study. Acta Orthop Traumatol Turc., 2025;59(3):152-155.

Background/Objectives: Reverse shoulder arthroplasty (RSA) has been widely used for the treatment of shoulder pathologies, particularly rotator cuff tear arthropathy. Currently, it is also increasingly performed for different indications. Like in any arthroplasty procedure, periprosthetic joint infection (PJI) is one of the most concerning complications and may have devastating outcomes. This study aimed to identify risk factors for PJI following RSA. Methods: This retrospective case-control study was conducted with patients who underwent RSA during the study period. Based on PJI occurrence during the follow-up period, patients were divided into two groups: Group I (no infection) and Group II (infection). The relationship between numerous clinical variables and PJI was tested. All variables were initially evaluated through univariate analysis between the two groups, and variables showing significant differences between the two study groups were subjected to multivariate logistic regression analysis to determine independent risk factors. Results: The study included 302 patients, with a mean age of 69.6 ± 10.1 years and a mean follow-up duration of 59.8 ± 24.7 months. During the follow-up period, PJI was not detected in 289 patients (95.7%) (Group I), while 13 patients (4.3%) developed PJI (Group II). Univariate analysis revealed a significant association between preoperative C-reactive protein (CRP) value (p = 0.001) and preoperative diabetes history (p = 0.007) with PJI. Multivariate logistic regression analysis, including these two variables, showed that diabetes was an independent risk factor for PJI development (p = 0.01, odds ratio = 4.85). Preoperative CRP elevation was not observed as an independent risk factor. Conclusions: This study demonstrated a significant association between high preoperative CRP levels and diabetes with PJI. Additionally, the presence of diabetes was identified as an independent risk factor for infection, with a 4.85-fold higher risk of PJI development in patients with a history of diabetes.