Psychologic reasons for patients preferring minimally invasive total hip arthroplasty

Success of an orthopaedic operation depends on patients achieving their primary goal(s) and having satisfaction with the outcome. The enthusiasm of patients for minimally invasive total hip arthroplasty seems related to satisfaction with the operation. We hypothesized patients' attitude toward a small incision would increase their confidence and satisfaction with the operation but the importance of the incision would dissipate after patients realized their goals of pain relief and functional recovery. One hundred sixty-five patients responded to a 14-question patient-perception questionnaire preoperatively and 6 weeks postoperatively and a followup survey at 6 months to 1 year postoperatively. One hundred nine patients had small incisions (mean, 9.6 cm) and 56 had long incisions (mean, 17.9 cm). Preoperatively patients expected small-incision surgery would positively influence their primary goals and satisfaction; at 6 weeks postoperative they believed more strongly that this was true. By 6 months to 1 year, the importance of the incision diminished because 100% of patients met their primary goals. Forty percent of patients with a long incision were not satisfied and the reasons given were related to the process of reincorporating their injured hip into their whole-body image. We confirmed our first hypothesis that a small incision influences a patient's satisfaction postoperatively; we could not confirm our second hypothesis that incision length did not matter after attaining primary goals.