Hip fractures are rising worldwide as populations age, making the choice between spinal and general anesthesia an important part of improving postoperative outcomes. Across eleven randomized trials, spinal anesthesia was associated with less intraoperative blood loss, slightly shorter hospital stays, and lower early opioid requirements. However, major outcomes such as delirium, serious adverse events, and 60-day mortality showed no meaningful differences between approaches. Newer data from the REGAIN trial found similar pain scores and long-term analgesic use between groups, though spinal anesthesia was linked to more shivering and general anesthesia to more sore throats. Both techniques appear safe, with modest short-term advantages for spinal anesthesia and substantial overlap in long-term patient experience.