<strong>Notas</strong> / <strong>Notes</strong> MIÉRCOLES / WEDNESDAY 53
MIÉRCOLES / WEDNESDAY 54 There are no data that indicate one small incision is better than another. Comparative studies of posterior mini-incisions to two-incision operations do not show superiority for pain and show conflicting data for functional differences. 8,27 The anterior “no muscle cut” incisions likewise have shown no superiority. Berger has not been able to achieve same-day surgery discharge with the anterior incision as he achieves with the two-incision operations (personal communication). Duwelius and coworkers 8 also had earlier discharge with the two-incision patients. A cadaver study suggests the anterior and posterior small incisions have similar muscle damage because of retraction force with the anterior incision. 32 Clinical results are not better in anterior incisions than published for posterior incisions, 12,23,26 and no randomized studies have been reported with anterior incisions. It would seem that surgeons who operate posteriorly should remain posterior, and those who do so anteriorly should continue to do so. This will eliminate the risk of additional stress for the surgeon, and complications, which would be present in changing the operative approach in addition to the incision length. Surgeons must accept the change in patient attitude, which has been the quintessential feature of the MIS experience. Today’s electronic age exponentially expands the patient’s community network through which they seek and gain knowledge for their health care. 11,12,19 Patients form expectations and develop optimism and decisiveness to overcome their disability if they gain information that gives them hope of regaining quickly their control of their social world. 14,18 Optimism and education will encourage the underserved patients to overcome their fears and elect to undergo the operations. 10,11,14,19 The surgeon must learn the expectations of each patient and strive to fulfill their goals. 13,14,20,21 If goals are unrealistic, the surgeon must take the time to direct the patient to acceptable achievable goals. Each surgeon must weigh the risk-to-benefit ratio of MIS THR for each patient based on surgical skill and experience, the culture of his/her community, and the mental health of the patient. REFERENCES 1. Kennon RE, Keggi JM, Wetmore RS, et al: Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am 85:39-48, 2003 (suppl 4) 2. Chimento GF, Pavone V, Sharrock N, et al: Minimally invasive total hip arthroplasty: A prospective randomized study. J Arthroplasty 20:139¬144, 2005 3. Floren M, Lester DK: Durability of implant fixation after less-invasive total hip arthroplasty. J Arthroplasty 21:783- 790, 2006 4. Berger RA, Jacobs JJ, Meneghini RM, et al: Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res 429:239-247, 2004 5. Gladwell M: The Tipping Point: How Little Things Can Make a Big Difference, 2002 6. Laupacis A, Bourne R, Rorabeck C, et al: The effect of elective total hip replacement on health-related quality of life. J Bone Joint Surg Am 75:1619-1626, 1993 7. Dorr LD, Maheshwari, Long WT, et al: Early pain and functional results comparing minimally invasive to conventional total hip arthroplasty: A prospective, randomized blinded study. J Bone Joint Surg Am 89:1153¬1160, 2007 8. Duwelius PJ, Burkhart RL, Hayhurst JO, et al: Comparison of the 2-incision and mini posterior total hip arthroplasty technique. J Arthroplasty 22:48-56, 2007 9. Hawker GA, Wright JG, Coyte PC, et al: Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med 342:1016-1022, 2000 10. Clark JP, Hudak PL, Hawker GA, et al: The moving target: A qualitative study of elderly patients’ decisionmaking regarding total joint replacement surgery. J Bone Joint Surg Am 86A:1366-1374, 2004 11. Hudak PL, Clark JP, Hawker GA, et al: “You’re perfect for the procedure! Why don’t you want it?” Elderly arthritis patients unwillingness to consider total joint arthroplasty surgery: A qualitative study. Med Decis Making 22:272- 278, 2002 12. Inaba Y, Dorr LD, Wan Z, et al: Operative and patient care techniques for posterior mini-incision total hip arthroplasty. Clin Orthop Relat Res 441:104-114, 2005 13. Mahomed NN, Laing MH, Cook EF, et al: The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol 29:1273-1279, 2002 14. Orbell S, Johnston M, Rowley D, et al: Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis. Soc Sci Med 47:93-102, 1998 15. Don LD, Thomas D, Long WT, et al: Psychologic reasons for patients preferring minimally invasive total hip arthroplasty. Clin Orthop Relat Res 458:94-100, 2007 16. Harris WH: Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint burg Am 51:737¬755, 1969 17. Ware JE Jr, Sherboume CD: The MOS 36-item shortform health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473-483, 1992 18. Hudak PL, McKeever PD, Wright JG: Understanding the meaning of satisfaction with treatment outcome. Med Care 42:718-725, 2004 19. Mancuso CA, Salvati EA, Johanson NA, et al: Patients’ expectations and satisfaction with total hip arthroplasty. J Arthroplasty 12:387-396, 1997 20. Bischoff-Ferrari HA, Lingard EA, Losina E, et al: Psychosocial and geriatric correlates of functional status after total hip replacement. Arthritis Rheum 51:829-835, 2004 21. Chamberlain K, Petrie K, Azariah R: The role of optimism and sense of coherence in predicting recovery following surgery. Psychology and Health 7:301-310, 1992 22. Woolson ST, Mow CS, Syquia JF, et al: Comparison of primary total hip replacements performed with a standard incision or a mini incision. J Bone Joint Surg Am 86, 2235-2244, 2004