title: Minimally invasive hip arthroplasty: what role does patient preconditioning play?
abstract: 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.
authors.affiliation: Rothman Institute of Orthopaedics, 925 Chestnut Street, Philadelphia, PA 19107, USA.
authors.forename: Aidin Eslam
authors.initials: AE
authors.lastname: Pour
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Peter F
authors.initials: PF
authors.lastname: Sharkey
authors.forename: William J
authors.initials: WJ
authors.lastname: Hozack
authors.forename: Richard H
authors.initials: RH
authors.lastname: Rothman
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010149:Postoperative Pain / Q000517:prevention & control*; D010351:Patient Discharge; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*