Abstract: Objective Both general anesthesia and spinal anesthesia were regularly used in the management of total hip arthroplasty.However,which type of anesthesia was better remained unclear.The present study was to compare the influences of general anesthesia and spinal anesthesia on patients underwent total hip arthroplasty. Method From January,2008 to October,2015,584 patients were retrospectively studied.The patients were assigned into general anesthesia group(n=302) and spinal anesthesia(n=282) according to anesthesia methods.The primary outcome measures included rate of any adverse event,deep vein thrombosis,cerebrovascular accident,pulmonary embolism,surgical site infection,urinary tract infection and mortality in the first 28 days.The second outcome measures were rate of tachycardia and hypotension during the operation,preoperative preparation time,operation time and postoperative room stay time. Result There was no difference between the two groups in gender,age,body mass index and the modified Charlson comorbidity score on admission.When compared with spinal anesthesia group,the patients in general anesthesia group got a significantly longer operation time(99.67±11.60 vs. 92.64±7.57 min,P<0.001),a significantly longer postoperative room stay time(16.26±2.44 vs. 12.98±1.97 min,P<0.001),a significantly higher rate of any adverse event(8.28% vs. 3.90%,P=0.028),a significantly higher rate of hypotension during the operation(29.47% vs. 19.86%,P=0.007),a significantly higher rate of deep vein thrombosis(2.65% vs. 0.35%,P=0.024) and a higher rate of blood transfusion(18.54% vs. 12.06%,P=0.03). Conclusion Spinal anesthesia contributed to lower rate of any adverse event and deep vein thrombosis in the first 28 days.Moreover,lower rate of intraoperative blood transfusion and hypotension,less operation time and postoperative room stay time were observed in spinal anesthesia group as well.