Bikini hip replacement

The term 'bikini hip replacement' is used to describe a variation on the anterior hip replacement technique that uses a slightly curved incision parallel to the groin crease, rather than a traditional vertical incision. Below the level of the skin, the technique is exactly the same as for the anterior approach.

Dr Williams is trained in this technique and will offer this to patients who would prefer a less visible scar, with suitable bony and soft tissue anatomy.

The main advantage of using a bikini incision for anterior total hip replacement, is a more cosmetic appearance to the final scar.  While the traditional vertical incision usually heals very neatly and is only 6-8cm long, in some patients can stretch out a little over time and is often visible below underwear or swimmers.

The bikini incision is oriented parallel to the tension lines of the skin (known as Langer's lines) and therefore tends to heal as a thin white line that doesn't stretch out over time.  Because it is higher up the thigh, it may also be hidden by undies or swimmers (although it's impossible to keep up with changing beach fashion!).

 

 

Bikini hip replacement scar
Bikini incision hip replacement scar at 6 weeks. Used with patient permission. Individual results may vary.
Bikini incision hip replacement scar
A 'bikini' incision hip replacement scar at 6 weeks in a male patient, hidden beneath underwear. Used with patient permission. Individual results may vary.

Are there any downsides to using a bikini incision?

If the scar heals more nicely and the approach is otherwise the same, it is natural to ask, 'well, why not use it for everyone?'  The main potential downside of using a horizontal incision is that it provides a small surgical window.  For more complex anatomy, a larger exposure is required and the vertical incision may be more appropriate.  Additionally, if revision surgery is required in the future, it may not be possible to use the same scar.

Using the bikini incision is also slightly more technically challenging for the surgeon, who needs to be well-trained and familiar with the technique.

Some scientific papers have compared the bikini incision with the traditional vertical incision with varied results. A study published in 2022 by Butler et al summarising the scientific literature reported that, compared to the traditional incision:

-overall satisfaction with the appearance of the scar is higher

-functional outcomes are no different

-wound healing may be slightly faster (especially in larger patients)

-rates of numbness below the scar due to stretch of the lateral femoral cutaneous nerve may be slightly higher, though not in all studies.

Bikini hip replacement FAQs