There are many approaches to the hip joint to perform a total hip replacement. Some of these were discussed in this article here. As a hip surgeon, it is important to know and have experience with all hip techniques and approaches in order to be familiar with the positives and negatives of each. The one chosen for your hip replacement is the one designed to give you the best outcome possible, with the least amount of risk.
The direct anterior approach is the hip replacement technique chosen because it provides an excellent profile when it comes to the benefits of this method. Over many years it has been refined, and has actually been in existence for over 28 years with the technique leaders being trained by some of the most world renowned surgeons in the hip and pelvis. Through refinements in technology, and understanding of the hip, it has developed to be one of the most elegant procedures for performing total hip replacement surgery.
This is the standard Direct Anterior Approach Incision
Over the years, the “Bikini Incision” has surfaced, as a further enhancement to the already minimally invasive direct anterior approach. It is also called the “Skin Crease” incision. The bikini incision was initially developed to aid wound healing, as it respects the normal skin fold lines in the anterior (front) part of the hip. In general, when the incision is made in parallel to these lines in the body, the scar is minimised. The main reasons why the bikini incision can be used is for:
- Minimising the appearance of the scar as it fades into the skin lines.
- Reducing the potential of wound breakdown in patients with larger abdominal overhands
- Aesthetically pleasing as it is less noticeable under the underwear as it is in line with a “bikini”.
Most of these reasons do not change the overall success of a hip replacement performed via the direct anterior approach, but were developed to further refine the aesthetics of it. We have been utilising the Bikini incision for all total hip replacement surgeries in female patients only, and select male patients for some time now. The improvement in aesthetics is certainly noticeable. For our larger patients, the superior wound healing capabilities when not cutting against the skin fold lines has also been noticeable.
The Blue line indicates the approximate line of the Bikini Incision
Whilst the bikini incision is not important for everyone, it is certainly an easy alternative to the vertical approaches that we routinely perform for the standard total hip replacement technique using the direct anterior approach. It does require a slightly longer incision length, with the average incision length using a bikini incision being 7cm (2.7 inches), and a standard approach being 6cm (2.3 inches). Over the years, many technological advances have allowed the ease of performing more minimally invasive surgery using special tools to avoid damaging the soft tissue during total hip replacement surgery. Along with Patient Specific Technology, the accuracy of total hip replacements has never been better.
Our routine is the use the bikini incision for all female patients, and the vertical standard incision for all of our male patients.
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