Over the last five years, there has been quite a bit of interest in minimally invasive joint replacement surgery. In the United States, this phenomenon started with several articles in the lay press extolling the virtues of less invasive surgery. Interest in this peaked one to two years ago and the enthusiasm for this type of approach has been dampened somewhat over the last year by reports of high complication rates and higher short-term failures in joint replacement using these techniques. The pendulum has swung back towards the middle and the majority of joint replacement surgeons are now using smaller incisions then were commonly used 10 years ago but have pulled back from trying to do hip and knee replacement through extremely small incisions. There are several factors that influence the patient’s recovery from joint replacement.
This size and health of the patient have a significant influence on the speed of recovery. More fit healthier individuals tend to get back on their feet faster than out of shape obese individuals. The perioperative pain management and rehabilitation programs also have significant influence on the speed of recovery. Less dissection around the hip or knee joint also aid in the short-term recovery but appear to have minimal impact on the results six months after surgery. Thanks to some of the champions of less invasive surgery, we have realized that we can obtain adequate visualization through smaller incisions while minimizing the amount of muscle damage. A recent study from the Mayo Clinic demonstrated that there was more muscle damage involved in the two-incision minimally invasive total hip technique popularized in Chicago than through a standard small posterior approach which is most commonly used in the United States. Emerging data like this has led to a more rational and logical approach to less invasive joint replacement. This is still a topic that is used to advertise practices and institutions. Suffice it to say, the results of joint replacement surgery are influenced by many factors and no one single factor ultimately determines the quality of the outcome.