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Minimally Invasive Hip Arthroplasty: What Role Does Patient Preconditioning Play?

¹ Rothman Institute of Orthopaedics, 925 Chestnut Street, Philadelphia, PA 19107

Investigation performed at the Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania

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Disclosure: In support of their research for or preparation of this manuscript, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Stryker. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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.

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