Impact of Regional Versus General Anaesthesia on Outcomes Following Total Knee Replacement: A Systematic Review and Meta-Analysis.

Total knee replacement (TKR) is widely performed for advanced osteoarthritis, and the choice between regional anaesthesia (RA) and general anaesthesia (GA) may influence perioperative outcomes. This systematic review and meta-analysis aimed to compare the impact of RA versus GA on outcomes following TKR. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted for comparative studies published between January 2010 and May 2025. Nine retrospective cohort studies encompassing 522,080 TKR procedures were included. RA was associated with significantly lower odds of blood transfusion (odds ratio (OR): 0.58; 95% confidence interval (CI): 0.44-0.77; p<0.001), fewer 30-day postoperative complications (OR: 0.59; 95% CI: 0.39-0.88; p=0.01), and a shorter hospital stay (standardised mean difference (SMD): -0.09; 95% CI: -0.14 to -0.04; p<0.001). Despite moderate-to-high heterogeneity, the direction of effect consistently favoured RA. These findings suggest that RA provides superior short-term outcomes compared with GA in TKR, supporting its preferential use, particularly in high-risk or elderly patients, while reinforcing the importance of individualised anaesthetic planning.