An arthritic or degenerative hip can be a source of significant discomfort. Left unaddressed, hip arthritis is a progressive condition that can lead to pain with everyday activities and can interfere with quality of life. When hip arthritis and its symptoms are severe, hip replacement is a reliable and durable treatment option for most patients. The anterior approach to hip replacement is a specific method for accessing the hip joint for replacement. It has specific advantages over other surgical approaches to the hip that have made it an increasingly popular method to perform total hip replacement.
More recently, the inguinal crease or "bikini" style incision for anterior approach hip replacement represents an improvement to this surgery that reduces wound complications and improves the cosmetics of the scar after anterior approach hip replacement.
Why Choose Anterior Approach for Hip Replacement?
Doctors can carry out hip replacement surgery through several different surgical approaches: posterior, direct lateral, anterolateral, and direct anterior.
The posterior approach is a traditional method for total hip replacement (THR), and it remains the most common approach utilized in the United States for THR. It involves accessing the hip through the large buttock muscle, the gluteus maximus. The lateral and anterolateral approaches involves accessing the hip from the side, often splitting or detaching a portion the gluteus medius muscle. In contrast, the direct anterior approach (DAA) to hip replacement means that the hip is accessed through the front of the hip joint. Only with the DAA can the hip joint can be accessed without cutting, splitting or detaching muscles.
Doctors consider numerous factors before deciding which approach to utilize for hip replacement. Those factors may include your body type, weight, anatomy, and medical history. Dr. McLawhorn believes that most patients are candidates for anterior approach surgery, except for those patients carrying around a lot of excess weight or those with prior plates, screws or rods that must be accessed through different scars.
The principal benefits for patients undergoing DAA THR are related to preservation of the muscles are the hip. The soft tissue sparing nature of the anterior approach leads to less risk of postoperative dislocation, less early postoperative pain, and easier mobility during the early part of recovery. The downside to anterior approach surgery is skin numbness over the lateral thigh, which is usually temporary and does not affect the muscles or functional recovery of the hip replacement. Superficial wound complications are also slightly higher for "longitudinal" anterior wounds - that is those wounds oriented vertically in front of the hip. Older women with elevated body mass index are at highest risk for these wound healing issues.
Differentiating Inguinal Crease "Bikini" Anterior Hip Replacement
Inguinal crease "bikini" anterior hip surgery involves the surgeon making surgical scar horizontally, rather than vertically, parallel to the patient’s bikini line. Executing the surgery in that manner helps conceal the scar resulting from the procedure for several reasons:
- Since the scar is hidden in the groin crease, the patient can easily cover it, making the location of the scar more discreet compared to the traditional "longitudinal" anterior approach scar.
- Our skin has a natural "grain" defined by the orientation of its collagen fibers. When surgical incisions are made in line or parallel with the grain of the skin, the scar will typically heal more cosmetically than when an incision is made against or perpendicular to the grain of the skin. The bikini incision is made parallel to the grain of the skin overlying the hip joint.
The expected recovery time for anterior hip replacement is around three months. However, patients may be well enough to move around with assistance only one day after the procedure.Â
Not everyone may be deemed eligible for inguinal crease bikini anterior hip surgery. If you are overweight, Dr. McLawhorn may recommend a different approach to hip replacement.
It is important to note that there are other factors that Dr. McLawhorn may take into consideration as well. He will consider your specific anatomy and previous surgical procedures. A thorough evaluation is critical to the success of this operation, as every patient is different.Â
There is probably a greater than 95% odds of total hip replacement lasting the rest of a patient's lifetime. The longevity of the prosthetic does have some dependency on patient-specific factors, including age, weight, and activity level.
There are many benefits for anterior hip replacement.Â
These benefits include the following:
- Faster recovery
- Less muscle damage
- Decreased risk of hip dislocation
- Improved mobilityÂ
- Less postoperative pain
Anterior hip replacement is a safe procedure, with an overall major complication rate of less than 2%. Research has shown that there is no increased risk for major complications with anterior approach surgery vs. other hip approaches. In fact, in a recent analysis of over 5,000 total hips performed at HSS, anterior approach surgery was associated with an 80% decreased risk of postoperative dislocation and also decreased risk of reoperation compared to posterior approach surgery.
Anterior approach surgery is associated with some minor postoperative issues, about which patients should be aware:
- Lateral thigh numbness - this is from disruption of small branches of the lateral femoral cutaneous nerve which supplies the skin only. Muscles and hip function are not affected. The numbness is usually temporary and resolves with time. The time to resolution is variable between patients, with some patients reporting resolution within days to weeks and other reporting resolution after 1 year.
- Wound healing issues - up to 3% of longitudinal anterior approach incisions may have wound issues that require special ointments or bandages to treat. The bikini incision has less than 1% of these issues. Older, female patients with elevated body mass index (BMI) are at highest risk for these wound issues.
Dr. McLawhorn will go over these risks in more detail during your consultation with him.Â
Dr. McLawhorn Makes Inguinal Crease "Bikini" Anterior Hip Surgery an Option
Check if you are eligible for inguinal crease bikini anterior hip surgery after consulting Dr. Alexander McLawhorn. Set your appointment with Dr. McLawhorn by calling 212-606-1065 if you’re seeking treatment in New York City or 203-705-2113 for his Stamford, CT, office.
