There is no consensus on the optimal anesthetic technique for primary Total Knee Arthroplasty (TKA). Spinal anesthesia (SA) and general anesthesia (GA) are most widely used and may have different outcomes with respect to early postoperative recovery. This retrospective cohort study aimed to compare postoperative quality of recovery between SA and GA for TKA, hypothesizing superior outcomes with SA.

This single-center, retrospective cohort study was conducted at Strasbourg University Hospital, France. Adult patients undergoing primary TKA between March 2020 and June 2023 were included if they were prospectively followed with the modified version of the French Quality of Recovery-15 (mQoR-15F) questionnaire. Patients managed with either GA or SA were compared. The primary endpoint was the difference in mean mQoR-15F score at postoperative days (POD) 1, 3, 14, and 28. Secondary endpoints included mQoR-15F subscales, hospital length of stay, and mortality.

447 cases were analyzed: 269 with GA (60.2%) and 178 with SA (39.8%). At POD 3, the SA group demonstrated a significantly higher mean mQoR-15F score (122.6 vs. 115.9, p   <  0.01), exceeding the minimal clinically important difference. No significant differences were observed at POD 1, 14, or 28. SA was associated with improved pain, physical comfort, autonomy, and psychological dimensions of the mQoR-15F at POD 3. SA group had shorter operating room occupancy. There were no differences in hospital stay, 28-day mortality, or postoperative nausea/vomiting.

Spinal anesthesia was associated with better early postoperative quality of recovery at POD 3 after TKA compared to general anesthesia.