Skin Crease ‘Bikini’ Incision for Anterior Approach Total Hip Arthroplasty: Surgical Technique and Preliminary Results
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The direct anterior approach for THA allows implantation through an internervous plane without muscle detachment from bone. However, the classic longitudinal skin incision does not follow the anatomic skin creases and can result in scar widening. We therefore modified our incision technique to a short oblique skin incision following the anatomic skin crease of the groin.
We sought to determine whether (1) the oblique incision leads to improved scar results compared with the longitudinal incision, (2) functional and pain scores are similar between the two approaches, and (3) the new incision is safe with respect to complications, blood loss, implant position, and lateral femoral cutaneous nerve (LFCN) symptoms.
Fifty-nine patients underwent THAs using either the classic (n = 33) or the new oblique incision (n = 26). At 6 months after surgery, we compared objective and subjective scar results, WOMAC, Oxford Hip and UCLA scores, blood loss, cup inclination, and the presence of LFCN symptoms between both groups.
Objectively, the modified incision resulted in significantly shorter and narrower scars. Subjectively, patients in the modified incision group were substantially more satisfied with the aesthetic appearance. Functional and pain scores were similar. No complications occurred in either group. Blood loss and cup inclination did not differ between the two groups. There were no differences in LFCN symptoms.
In this series, which selected for thinner patients in the study group, the ‘bikini’ incision for an anterior approach THA led to improved scar cosmesis and was found to be safe in terms of blood loss, appropriate component placement, and risk for LFCN injury.
Level of Evidence
Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.
- Bhargava T, Goytia RN, Jones LC, Hungerford MW. Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedics. 2010;33:472.
- Biedermann R, Donnan L, Gabriel A, Wachter R, Krismer M, Behensky H. Complications and patient satisfaction after periacetabular pelvic osteotomy. Int Orthop. 2008;32:611–617. CrossRef
- Bremer AK, Kalberer F, Pfirrmann CW, Dora C. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg Br. 2011;93:886–889.
- Clark BC. In vivo alterations in skeletal muscle form and function after disuse atrophy. Med Sci Sports Exerc. 2009;41:1869–1875. CrossRef
- Goebel S, Steinert AF, Schillinger J, Eulert J, Broscheit J, Rudert M, Nöth U. Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop. 2012;36:491–498. CrossRef
- Goulding K, Beaulé PE, Kim PR, Fazekas A. Incidence of lateral femoral cutaneous nerve neurapraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res. 2010;468:2397–2404. CrossRef
- Ito Y, Matsushita I, Watanabe H, Kimura T. Anatomic mapping of short external rotators shows the limit of their preservation during total hip arthroplasty. Clin Orthop Relat Res. 2012;470:1690–1695. CrossRef
- Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res. 2011;469:503–507. CrossRef
- Masonis J, Thompson C, Odum S. Safe and accurate: learning the direct anterior total hip arthroplasty. Orthopedics. 2008;31:pii:orthosupersite.com/view.asp?rID=37187.
- Mast NH, Muñoz M, Matta J. Simultaneous bilateral supine anterior approach total hip arthroplasty: evaluation of early complications and short-term rehabilitation. Orthop Clin North Am. 2009;40:351–356. CrossRef
- Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res. 2005;441:115–124. CrossRef
- Naal FD, Impellizzeri FM, Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty. Clin Orthop Relat Res. 2009;467:958–965. CrossRef
- Naal FD, Sieverding M, Impellizzeri FM, von Knoch F, Mannion AF, Leunig M. Reliability and validity of the cross-culturally adapted German Oxford hip score. Clin Orthop Relat Res. 2009;467:952–957. CrossRef
- Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty. 2009;24:698–704. CrossRef
- Rachbauer F. Minimally invasive total hip arthroplasty: anterior approach. Orthopade. 2006;35:723–724, 726–729.
- Rachbauer F, Kain MS, Leunig M. The history of the anterior approach to the hip. Orthop Clin North Am. 2009;40:311–320. CrossRef
- Seng BE, Berend KR, Ajluni AF, Lombardi AV Jr. Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin North Am. 2009;40:343–350. CrossRef
- Stucki G, Meier D, Stucki S, Michel BA, Tyndall AG, Dick W, Theiler R. [Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index][in German]. Z Rheumatol. 1996;55:40–49.
- Yakovlev AE, Resch BE, Karasev SA. Treatment of intractable hip pain after THA and GTB using peripheral nerve field stimulation: a case series. WMJ. 2010;109:149–152.
- Skin Crease ‘Bikini’ Incision for Anterior Approach Total Hip Arthroplasty: Surgical Technique and Preliminary Results
Clinical Orthopaedics and Related Research®
Volume 471, Issue 7 , pp 2245-2252
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
- 2. University of Duisburg-Essen, Essen, Germany
- 3. Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany