Purpose

To investigate the difference in efficiency and patient outcomes between spinal and general
anesthesia in the setting of hip arthroscopy for femoroacetabular impingement.

Methods

A retrospective review was performed on all patients undergoing hip arthroscopy for FAI
operated on by one surgeon (T.W.) from 2021-2023. Operative notes, nursing records and a
prospectively maintained registry of patients undergoing hip arthroscopy for FAI were reviewed.
The surgeries were completed at three different surgical sites, two of which exclusively
performed spinal anesthesia and the third site exclusively performed general anesthesia.
Traction time, the number of air arthrograms required to achieve adequate distraction, total
operating room time, total surgical time and total PACU time were also included.

Results

There were 192 patients in the spinal group and 42 patients in the general group. The average age
was 36.8 in the spinal group, 37.1 in the general group. The mean number of anchors used for
labral repair was 3.25 in both groups. There were no statistically significant differences between
pre-operative tonis grades, alpha angles and LCEAs. There were no statistically significant
differences between the PROMIS physical function scores, iHOT-12 scores, hip outcome scores
for ADL and sport between both groups at baseline, 3 months and 1 year post operatively. Total
operating room time (wheels in to wheels out) was 140.13 minutes in the spinal group and
149.22 minutes in the general group (p=0.027). Total surgical time was 97.46 minutes in the
spinal group and 97.89 minutes in the general group (p=0.918). Total PACU time was 84.79
mins in the spinal group and 110.13 mins in the general group (p<0.001). Total traction time was
41.5 mins in both groups. The percentage of cases requiring an air arthrogram to achieve hip
distraction was 10% in the spinal group and 16% in the general group (p=0.251).

Conclusion

Spinal and general are both effective forms of anesthesia for hip arthroscopy in the setting of
FAI, however spinal anesthesia is more efficient, leading to less time spent in the operating room
and in the PACU. The increased efficiency of spinal anesthesia also has no detriment on patient
outcomes at 3 months and 1 year.