Incidence of spinal-epidural haematoma after neuraxial anaesthesia for total hip and knee arthroplasty: a single-centre analysis of 96 103 consecutive cases from 2013 to 2023.

Abstract

Epidural haematoma (EH) is a rare but serious complication of neuraxial anaesthesia. The incidence varies in the published literature, and contemporary procedure- and population-specific estimates are lacking. We estimated the incidence of EH after neuraxial anaesthesia for total joint arthroplasty. We further present an evidence-based algorithm for interdisciplinary management. This is a single-centre, retrospective analysis of consecutive patients who underwent primary unilateral or bilateral total hip or knee arthroplasty under spinal, epidural, or combined spinal-epidural anaesthesia from January 2013 to December 2023. EH was identified through a search of two institutional databases (radiology and quality assurance). The medical records of cases with radiologically confirmed EH were reviewed to describe the clinical course and outcomes. The primary outcome was an estimate of the frequency of EH by primary anaesthetic type. Of the total of 96 103 patients, 75 205 patients received spinal anaesthesia and 20 898 patients received either epidural (n=1588) or combined spinal-epidural anaesthesia (n=19 310). We identified one case of symptomatic EH after total hip arthroplasty under combined spinal-epidural anaesthesia requiring urgent lumbar decompression surgery with EH evacuation. We identified one case of asymptomatic EH after epidural anaesthesia, managed conservatively. The estimated population frequencies were 1:10 000 (95% CI: 0.1-3.5:10 000) epidural or combined spinal-epidural anaesthetics and 0:75 000 (95% CI: 0-0.05:10 000) spinal anaesthetics. We found a low incidence of EH following total joint arthroplasty performed under neuraxial anaesthesia. Although spinal anaesthesia was performed almost four times more frequently, EH was exclusively associated with epidural techniques. Prompt recognition and interdisciplinary collaboration are essential for optimal outcomes.