Background: The benefits of minimally invasive total hip
arthroplasty continue to be debated. The objective of this study was to
investigate the role of patient education, accelerated rehabilitation, and
improved pain control on the outcome of total hip arthroplasty performed
through a small incision.
Methods: One hundred patients undergoing total hip arthroplasty at
our institution were randomized into one of four groups on the basis of the
size of the incision, preoperative counseling, the type of preoperative and
postoperative rehabilitation, and the analgesia protocol. The operative
parameters, complications, time to discharge to home, functional improvement,
and patient satisfaction were assessed.
Results: The demographic distribution among the four groups was
similar. The extent of functional improvement at the time of discharge to
home, patient satisfaction, and walking ability at the time of discharge were
better in patients who had received an accelerated preoperative and
postoperative rehabilitation regimen regardless of the size of the incision.
There was no difference in estimated blood loss, mean operative time,
transfusion needs, or complications among the groups.
Conclusions: This study highlights the importance of factors such as
family education, patient preconditioning, preemptive analgesia, and
accelerated preoperative and postoperative rehabilitation in influencing the
outcome of total hip arthroplasty. The aforementioned factors, and not the
surgical technique per se, may play a major role in imparting the better
outcome after minimally invasive total hip arthroplasty that has been reported
by various investigators.
Level of Evidence: Therapeutic Level II. See Instructions
to Authors for a complete description of levels of evidence.