General anesthesia for joint replacement is one of the first things patients ask me about once they decide on surgery. Most want to know two things: will I feel anything, and is it safe?
After more than twenty years and more than 700 hip and knee replacements a year, here is my honest answer. General anesthesia is safe, reliable, and the right choice for many people, even though most of my patients have a spinal instead.
One note on roles: I am the surgeon. Your anesthesia plan comes from a board-certified anesthesiologist, a doctor trained only in anesthesia.
This article covers general anesthesia alone. For every option side by side, read my guide to joint replacement anesthesia options.
What is general anesthesia for joint replacement?
General anesthesia for joint replacement is a controlled, deep unconsciousness. It lets your surgeon replace your hip or knee while you feel nothing and remember nothing. A spinal numbs only the lower body; general anesthesia acts on the brain and the whole body.
People call it “going to sleep,” but it is deeper than normal sleep. The medicine goes in through your IV and often as a gas you breathe. Your anesthesiologist adjusts the dose minute by minute.
General anesthesia relaxes the muscles you use to breathe. So once you are asleep, your team places a breathing tube or a softer airway device (a laryngeal mask). A machine helps you breathe until surgery ends, and most patients never remember it.
What happens during general anesthesia for hip or knee replacement?
You fall asleep within a minute or two in the operating room, and the next thing you remember is waking up in recovery. Here is what happens around that.
Before you fall asleep
You meet your anesthesiologist before surgery. They review your health, your medicines, and any past anesthesia problems, and an IV is placed. Many patients also get a nerve block for pain control.
In the operating room, monitors go on your chest, arm, and finger. You breathe oxygen through a soft mask, the medicine goes into your IV, and you drift off.
While you are asleep
A member of the anesthesia team stays with you the whole time. They watch your heart, blood pressure, oxygen, breathing, and temperature. Most hip and knee replacements take one to two hours.
Waking up
When surgery ends, the medicines are turned off and you start to wake. The breathing tube comes out once you breathe well on your own, usually before you are fully awake. Nurses then watch you in recovery and treat any pain or nausea.
When is general anesthesia used for joint replacement?
General anesthesia is used when a spinal is not safe, not practical, or not the best fit for the patient. In my practice, most hip and knee patients have a spinal with sedation.
But general anesthesia is not a lesser option. It is the right tool for specific situations.
Medical reasons a spinal may not be safe
- Blood thinners that cannot be stopped in time, such as warfarin, clopidogrel, apixaban, or rivaroxaban. A needle near the spine carries a small bleeding risk.
- Bleeding or clotting disorders, or abnormal blood test results.
- Prior spine surgery with hardware or scar tissue that makes a spinal hard to place.
- Certain heart conditions, such as a badly narrowed heart valve (aortic stenosis). A spinal can drop blood pressure too fast.
- A skin infection on the lower back, or an allergy to local anesthetics.
- Some nerve or brain conditions that your anesthesiologist will review with you.
Surgical and personal reasons
Long or complex cases, such as a revision (redo) joint replacement, may call for general anesthesia. It lasts as long as the surgery needs. It is also the backup if a spinal does not fully work, which is uncommon.
Some patients are simply very anxious about a needle in the back. That preference matters, and your anesthesiologist will weigh it with you.
What are the benefits of general anesthesia for joint replacement?
The main benefit of general anesthesia is complete, predictable unconsciousness for the whole operation. Other advantages:
- It starts quickly and works for nearly every patient.
- You have no awareness or memory of the operation.
- Your anesthesiologist has full control of your breathing and airway.
- It keeps muscles relaxed, which can help during longer or more complex cases.
- No needle is placed in your back.
Here’s what I tell my patients: the best anesthetic is the one that is safest for your body. For some people, that is clearly general anesthesia.
What are the risks and side effects of general anesthesia?
General anesthesia is very safe for healthy adults. Most side effects are mild and fade within a day, and serious problems are rare. Your risk depends mostly on your health, especially your heart and lungs.
Common, short-lived side effects
| Side effect or risk | How common | How long it lasts | What helps |
|---|---|---|---|
| Nausea or vomiting | Common (up to 4 in 10 in some reports) | A few hours to a day | Anti-nausea medicine before and after surgery |
| Sore throat or hoarse voice | Common | 1 to 2 days | Cool drinks and throat lozenges |
| Grogginess or dizziness | Common | Up to 24 hours | Rest; no driving for a full day |
| Short-term confusion (delirium) | More common in older adults | Hours to a few days | Sleep, early walking, family nearby |
| Chipped or loose tooth | Uncommon | Until repaired by a dentist | Report loose teeth or dentures before surgery |
| Serious allergic reaction | Rare | Treated right away in the operating room | Share every known allergy |
| Heart attack, stroke, or pneumonia | Rare; higher with heart or lung disease | Varies | A full health review before surgery |
| Waking during surgery (awareness) | Very rare | Not applicable | Constant monitoring by the anesthesia team |
Rare but serious risks
Rare risks include heart attack, stroke, breathing problems, pneumonia, a serious allergic reaction, and a chipped tooth from the breathing tube. Waking during surgery (awareness) is very rare. The American Academy of Orthopaedic Surgeons notes these risks rise with heart disease or lung disease such as COPD.
A severe inherited reaction called malignant hyperthermia can be triggered by certain anesthetic gases. Tell your team if anyone in your family has had a bad reaction to anesthesia.
Is general anesthesia for joint replacement riskier for older adults?
Age alone does not rule out general anesthesia. Your heart, lungs, and overall health matter more than your birthday. The bigger worry in older patients is delirium, a sudden and usually brief spell of confusion after surgery.
In a 2021 trial of 1,600 older adults having hip fracture surgery, delirium rates were about the same with spinal and general anesthesia. Good sleep, early walking, and family nearby help most patients clear quickly.
How does general anesthesia compare with a spinal for joint replacement?
Both are safe and effective, but a spinal has a small edge for most healthy patients. In one study of more than 382,000 hip and knee replacements, the 30-day death rate was 0.18 percent with general anesthesia and 0.10 percent with a spinal or epidural.
That study looked back at records, and some trials find no difference. I read these numbers as “both are very safe.”
A spinal also means less nausea and blood loss, so I favour it when it fits. My joint replacement anesthesia guide covers the full comparison.
How can I prepare for general anesthesia before joint replacement?
The best way to prepare for general anesthesia is to give your team a full, honest picture of your health. Small details change the plan. Before surgery:
- Bring a written list of every medicine, vitamin, and supplement you take.
- Follow fasting instructions exactly. An empty stomach lowers the chance of stomach contents reaching the lungs.
- Mention weekly GLP-1 shots for diabetes or weight loss, such as semaglutide or tirzepatide. They slow the stomach, so your team may change your instructions.
- Report sleep apnea, loose teeth, or dentures, plus any past anesthesia problems in you or your family.
- Stop smoking as early as you can; even a few weeks helps your lungs.
- Arrange a driver and an adult to stay with you for the first 24 hours if you go home the same day.
After surgery, several gentle pain medicines work together to keep you comfortable with fewer opioids. Learn more about nonopioid pain treatment for joint surgery.
How we handle general anesthesia for joint replacement in Franklin, TN
At the Bone and Joint Institute of Tennessee in Franklin, our anesthesia team reviews every patient before surgery. The anesthetic is matched to the person. We care for patients from Franklin, Nashville, Brentwood, Columbia, and across Middle Tennessee.
Many of my patients have their hip replacement or knee replacement as same-day outpatient surgery. General anesthesia does not rule that out. What matters most is a plan built around your health.
If you are weighing hip or knee replacement, request a consultation with Dr. Calendine or call (615) 791-2630. Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067.
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Medical disclaimer: This article is general orthopaedic patient education and does not replace professional medical advice. Anesthesia decisions are individual; always ask your surgeon and anesthesiologist what is safest for you. Individual results vary based on personal health circumstances.
References
- Memtsoudis SG, Sun X, Chiu YL, et al. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013;118(5):1046-1058. doi:10.1097/ALN.0b013e318286061d
- Memtsoudis SG, Cozowicz C, Bekeris J, 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). Br J Anaesth. 2019;123(3):269-287. doi:10.1016/j.bja.2019.05.042
- Neuman MD, Feng R, Carson JL, et al. Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med. 2021;385(22):2025-2035. doi:10.1056/NEJMoa2113514
- Turnbull ZA, Sastow D, Giambrone GP, Tedore T. Anesthesia for the patient undergoing total knee replacement: current status and future prospects. Local Reg Anesth. 2017;10:1-7. doi:10.2147/LRA.S101373
- Memtsoudis SG, Cozowicz C, Bekeris J, et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group. Reg Anesth Pain Med. 2021;46(11):971-985. doi:10.1136/rapm-2021-102750
