Regional Versus General Anesthesia for Promoting Independence After Hip Fracture

Hip fracture is a clinical condition that involves a break in the femur (hip bone) near where
it attaches to the pelvis. Hip fractures occur more than 300,000 times each year in the US
and over 1.6 million times each year worldwide.

Over 90% of hip fractures occur in individuals aged 50 or older, most commonly resulting from
low-energy traumatic injuries, such as falls from standing in the context of established
osteoporosis, chronic illness, or disability. Surgical treatment, via fixation of the
fractured bone or partial or total replacement of the hip joint, is indicated for all types
of hip fractures and approximately 95% of hip fracture patients undergo surgery.

No evidence-based interventions now exist to improve functional outcomes after hip fracture
surgery beyond the immediate postoperative period. Nearly all hip fracture patients require
orthopedic surgery and anesthesia,making the anesthetic care episode a major opportunity to
impact outcomes.

Spinal and general anesthesia represent the two standard care approaches to anesthesia for
hip fracture surgery. Basic and clinical research has identified multiple plausible
mechanisms by which spinal anesthesia may improve outcomes after hip fracture; nonetheless,
major guidelines and systematic reviews have identified key evidence gaps and anesthesia care
for hip fracture varies markedly in practice. While spinal and general anesthesia for hip
fracture have been previously compared in retrospective studies and small randomized trials,
much of the available prospective trial data is old and may not be reflective of current
clinical practice.

REGAIN will be the first pragmatic multicenter prospective randomized trial of spinal versus
general anesthesia for hip fracture surgery designed to evaluate the association of
anesthesia technique with functional recovery after hip fracture. As such, it will fill
critical evidence gaps to inform policy and practice.

Inclusion Criteria:

- Clinically or radiographically diagnosed intracapsular or extracapsular hip fracture

- Planned surgical treatment via hemiarthroplasty, total hip arthroplasty or appropriate
fixation procedure

- Ability to walk 10 feet or across a room without human assistance before fracture

Exclusion Criteria:

- Planned concurrent surgery not amenable to spinal anesthesia

- Absolute contraindications to spinal anesthesia

- Periprosthetic fracture