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Oblique Bikini Incision Versus Longitudinal Incision for Direct Anterior Approach Total Hip Arthroplasty: A

Yi Leng¹, Jianzeng Zhang¹, Xin Qi¹

¹Department of Orthopaedic Surgery The First Hospital of Jilin University Jilin China.

Health Science Reports

|May 13, 2026

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The bikini incision in direct anterior approach total hip arthroplasty (DAA-THA) offers better scar cosmesis without increasing operative time. However, high-quality studies indicate a potential increased risk of lateral femoral cutaneous nerve (LFCN) injury.

Area of Science:

Orthopedic Surgery
Surgical Techniques
Arthroplasty

Background:

Standard direct anterior approach (DAA) total hip arthroplasty (THA) uses longitudinal incisions, potentially impacting scar esthetics.
The bikini incision, an alternative oblique approach, aims for improved cosmetic outcomes but raises concerns about lateral femoral cutaneous nerve (LFCN) injury.

Purpose of the Study:

To systematically compare the safety, functional, and esthetic outcomes of the bikini incision versus the traditional longitudinal incision in DAA-THA.
To evaluate scar cosmesis, LFCN injury incidence, operative time, and wound complications.

Main Methods:

Systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
Inclusion of comparative studies (RCTs and observational cohorts) comparing bikini and longitudinal incisions in DAA-THA.

Keywords:

bikini incision direct anterior approach lateral femoral cutaneous nerve meta‐analysis scar cosmesis total hip arthroplasty

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Pooled analysis using random-effects models with subgroup analyses based on study design.

Main Results:

The bikini incision showed significantly superior scar cosmesis (SMD = -0.62, p = 0.001) and no significant increase in operative time (MD = -0.52 min, p = 0.63).
Overall LFCN injury risk was not significantly different (OR = 1.19, p = 0.61), but high-quality RCTs indicated a higher risk with the bikini incision (OR = 2.15, p = 0.005).
A trend towards reduced wound complications was observed with the bikini incision (OR = 0.42, p = 0.09).

Conclusions:

The bikini incision provides superior esthetic outcomes in DAA-THA without prolonging surgery and may reduce wound complications.
Surgeons must be aware of the increased risk of LFCN injury associated with the bikini incision, particularly in high-quality RCTs.
This approach is recommended for experienced surgeons proficient in DAA-THA.