title: Skin crease 'bikini' incision for anterior approach total hip arthroplasty: surgical technique and preliminary results.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland. michael.leunig@kws.ch
authors: Michael
authors: M
authors: Leunig
authors: Michael
authors: M
authors: Faas
authors: Fabian
authors: F
authors: von Knoch
authors: Florian D
authors: FD
authors: Naal
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001696:Biomechanical Phenomena; D016063:Blood Loss, Surgical; D002921:Cicatrix / Q000209:etiology; D005260:Female; D005267:Femoral Nerve / Q000293:injuries; D006119:Groin; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D059348:Peripheral Nerve Injuries / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome