Drs. Memtsoudis et al from the Hospital for Special Surgery in New York published in the Journal of Arthroplasty in May 2013 a large national data base study looking at 400 hospitals from 2006 through 2010. They evaluated the anesthesia type and outcomes for patients undergoing primary and total hip and knee arthroplasty. They evaluated 382, 236 patients. Eleven percent of these patients had a spinal/epidural type anesthetic and 14 percent a spinal/epidural plus general anesthetic and 75 percent had a general anesthetic. After reviewing this large national data base they found several significant findings. First, the patients who had a spinal or epidural anesthetic had a significantly lower 30 day mortality rate after their surgical procedure. They also noted a significantly lower length of stay in the hospital and decreased costs and in-hospital complications with the spinal anesthetic group. They concluded that spinal and/or epidural anesthetic was associated with superior perioperative outcomes for primary hip and knee replacement when compared to general anesthesia. We perform the overwhelming majority of our joint replacements with a spinal anesthetic and use general only for those who are unable to have a spinal type anesthetic due to prior back surgery and/or specific medical conditions. We feel this gives the patient the best opportunity for an early successful outcome.