Perioperative Anesthetic Management and Early Outcomes Following Primary Total Hip Arthroplasty: A Retrospective Cohort Study in a Moroccan Tertiary Center.

Background Total hip arthroplasty (THA) is a highly effective surgical procedure for advanced hip disease. Perioperative anesthetic management plays a key role in optimizing outcomes, particularly in resource-limited settings where patient characteristics, blood management strategies, and perioperative practices may differ from those reported in high-income countries. Methods  We conducted a retrospective cohort study including 103 adult patients who underwent primary elective THA at a Moroccan tertiary university hospital between January 2024 and December 2025. Data collected included demographic characteristics, comorbidities, ASA physical status, anesthetic techniques, intraoperative blood loss, transfusion requirements, airway characteristics, and postoperative outcomes. Descriptive statistical analysis was performed. Results  The cohort was relatively young (mean age 46.4 ± 14.1 years) with a male predominance (sex ratio, 1.5), reflecting a different epidemiological profile compared with Western series. Nearly half of the patients (48.5%) had at least one comorbidity. Spinal anesthesia was the predominant technique (70%). Mean intraoperative blood loss was substantial (800 mL, range 100-1900 mL), with a transfusion rate of 14%. Difficult airway features were mainly observed in patients with underlying rheumatologic conditions. Early postoperative complications were limited, with one surgical site infection. During follow-up, complications occurred in 6.8% of patients, including prosthetic dislocation and aseptic or septic loosening. No mortality was reported. Conclusion  This study highlights a distinct THA population characterized by younger age and significant perioperative blood loss. Spinal anesthesia was widely used in this cohort and was associated with overall favorable short-term outcomes. Blood management remains a major challenge, particularly in settings where standardized strategies such as systematic tranexamic acid use may not be consistently implemented.