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Bikini versus Traditional Incision in DAA THA: Patient Satisfaction, Surgeon Observation, and LFCN Damage
Maharshi S Nagda1,2,3, Lyndsay E Somerville2,3, Michael Shehata2
1Western University, London, Ontario, N6A 3K7, Canada.
Orthopedic Research and Reviews
|September 12, 2025
Summary
The bikini incision (BI) for direct anterior approach total hip arthroplasty (DAA THA) offers superior scar aesthetics and patient satisfaction compared to the traditional vertical incision (TI). The BI also demonstrates better preservation of lateral femoral cutaneous nerve (LFCN) sensation.
Area of Science:
- Orthopedic Surgery
- Surgical Techniques
- Anatomy
Background:
- The bikini incision (BI) in direct anterior approach total hip arthroplasty (DAA THA) aims for improved scar aesthetics.
- Concerns exist regarding the BI's transverse orientation potentially increasing lateral femoral cutaneous nerve (LFCN) injury risk.
Purpose of the Study:
- To compare patient and surgeon satisfaction with scar appearance between the bikini incision (BI) and traditional vertical incision (TI) in DAA THA.
- To evaluate differences in post-operative LFCN sensation between BI and TI.
- To assess the incidence of LFCN sensory disturbance in patients undergoing DAA THA with BI versus TI.
Main Methods:
- A pilot study involving 55 patients (32 TI, 23 BI) at least 6 months post-DAA THA.
- Scar assessment using the Patient and Observer Scar Assessment Scale (POSAS) for patient and surgeon evaluations.
- LFCN sensation evaluated via monofilament testing across four anterior thigh quadrants.
Main Results:
- BI patients and surgeons reported significantly higher scar satisfaction compared to the TI group (p < 0.05).
- Monofilament testing revealed significantly less LFCN impairment in the inferomedial quadrant for the TI group (p < 0.0125).
Conclusions:
- The bikini incision (BI) leads to improved patient and surgeon satisfaction with scar appearance in DAA THA.
- Contrary to prior assumptions, the BI appears to better preserve LFCN innervation compared to the traditional vertical incision (TI).
