MINIMALLY INVASIVE HIP ARTHROPLASTY: WHAT OTHER FACTORS PLAY A ROLE?

Abstract

Introduction: The potential benefits of Minimally invasive total hip arthroplasty (MIS THA) continues to be heavily debated. We hypothesized that the potential benefits of MIS THA may relate to factors such as patient selection, patient preconditioning, improvements in anesthesia technique, pain management, and not the incision size. This randomized, prospective study was designed to investigate the role of these confounding factors in general and aggressive rehabilitation in particular on the outcome of THA.

Methods: 100 patients undergoing THA at our institution were randomized into one of four groups. Group A was patients who had standard THA (incision length> 10 cm) and received standard preoperative and postoperative care. Group B patients had THA using small incision (< 10 cm) and standard protocols. Group C patients had regular incision THA, but received aggressive rehabilitation and pain control regimen. Group D patients had THA through small incision and received aggressive regimen.

Results: The demographic distribution amongst all the groups was similar. There was a significant improvement in function as measured by Harris Hip Score, LASA (validated rehabilitation score), SF-36, and lower extremity function test in all groups. The extent of functional improvement, home discharge, patient satisfaction, and analgesia requirement was better in patients who received aggressive preoperative and postoperative care regimen regardless of the size of their incision. There was no difference in estimated blood loss, mean operative time, transfusion needs, and complications between the groups.

Discussion: This study highlights the importance of family education, patient conditioning, pre-emptive analgesia, and aggressive preoperative and postoperative rehabilitation in influencing the outcome of THA. The aforementioned factors, and perhaps not the surgical technique per se, may play a major role in imparting advantageous outcome to MIS THA that is reported by various investigators.