Incidence and Risk Factors for Post-Dural Puncture Headache (PDPH) in Patients Receiving Neuraxial…

Cohort studyHSS journal : the musculoskeletal journal of Hospital for Special Surgery· Aug 2026

Incidence and Risk Factors for Post-Dural Puncture Headache (PDPH) in Patients Receiving Neuraxial Anesthesia for Total Joint Arthroplasty: A Retrospective Case Series.

William P Qiao, Juliet E Rowe, Pa Thor … Bradley H Lee

Obstetric AnesthesiaCohort studyPrognosisQ2IF 1.5

Only 4.5% of unintended dural punctures in joint replacement surgery caused headache

Incidence and Risk Factors for Post-Dural Puncture Headache (PDPH) in Patients Receiving Neuraxial Anesthesia for Total Joint Arthroplasty: A Retrospective Case Series.

William P Qiao … Bradley H Lee

HSS journal · Aug 2026

Background

Post-dural puncture headache (post-dural puncture headache) after unintended dural puncture is a known complication of neuraxial anesthesia, especially with puncture by 20 gauge or larger catheter or needle.

Purpose

We sought to answer the following questions: What is the incidence of post-dural puncture headache after unintended dural puncture in the total joint arthroplasty population?

Methods

A retrospective chart review was performed for patients undergoing total joint arthroplasty surgeries under neuraxial anesthesia between January 1, 2016, and April 30, 2023, at a single high-volume orthopedic hospital.

n = 640 patients

Results

4.5%

headache was rare, most dural punctures didn't lead to it

n = 640 patients

More results

The final logistic regression identified older age and higher body mass index (BMI) as protective and associated with reduced risk of post-dural puncture headache.

Among the 29 post-dural puncture headache cases, non-steroidal anti-inflammatory drugs were employed in 86.2% of patients, and acetaminophen was used in 93.1%.

More results

Seven patients (24.1%) required an epidural blood patch, and 3 (10.3%) reported long-term sequelae.

“

Conclusion · 1 of 2

This large retrospective case series of total joint arthroplasty patients at a single institution found that the incidence of post-dural puncture headache after unintended dural puncture was low (4.5%).

Conclusion · 2 of 2

Lower age and lower BMI were risk factors associated with higher odds of being diagnosed with post-dural puncture headache. LEVEL OF EVIDENCE: Level IV: retrospective case series.

Incidence and Risk Factors for Post-Dural Puncture Headache (PDPH) in Patients Receiving Neuraxial Anesthesia for Total Joint Arthroplasty: A Retrospective Case Series.

Incidence and Risk Factors for Post-Dural Puncture Headache (PDPH) in Patients Receiving Neuraxial Anesthesia for Total Joint Arthroplasty: A Retrospective Case Series.

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