Bikini Hip Replacement | Anterior Hip Replacement Scars

What is Bikini Hip Replacement?

A true minimally invasive (mini incision) muscle sparing (inter-muscular and inter-nervous plane) approach.
It preserves the muscles and tendons without cutting them.
Hidden scar in groin crease.
Anterior hip Replacement surgery has been carried out in Europe for several decades (Hueter Approach) with excellent outcomes.
Smaller incision than the traditional posterior/lateral or anterolateral approaches.

Who is Suitable for Bikini Hip Surgery ?

The main indications for Bikini hip replacement:
Significant Arthritis/inflammatory process (rheumatoid) affecting the hip joint resulting in increased pain, reduced mobility and function.
It can also be performed for fractured hips in some cases.
Exceptions: Very Obese or Very Muscular patients, which makes the surgery technically difficult even in the most experienced hands. Bikini Hip surgery can be difficult to perform in cases of complex revision hip surgery where a traditional posterior hip replacement is better.

Is Bikini Hip Replacement the Best?

There are advantages and disadvantages between different approaches and Dr. Nizam was trained in all the approaches.
Dr. Nizam has done one of the largest series of these operations in Australia.
Bikini Anterior Hip replacements certainly has advantages over traditional hip surgery with less pain and faster recovery.
 The Facts: Bikini Vs Standard Posterior Hip Replacement:
  Bikini Approach Posterior Approach
 Patient position  on you back  on your side
 Traction Table to distract hip  Usually Used (Dr. Nizam does not use a traction table)  Not Used
 Incision Site  Groin  On the side/back of hip
 Incision length  6-9cm (variable)  9-15cm (variable)
 Minimally Invasive Surgery  Yes  Yes – Applicable
 Exceptions  In Obese, Muscular patients and Revision hip surgery  Generally allows easy access and is the most commonly used
 Muscle Preservation  Mostly (except sometimes surgeon release piriformis muscle)  Gluteus muscle is split (not cut) and short external rotator (tendons) are cut then repaired – NO muscles are cut.
 Risk of Nerve Damage  Risk of injury to lateral femoral cutaneous to thigh (8-40%) but no functional limitations  Usually no risk, but very small risk to sciatic nerve
 Special Training  Yes but can be part of training program  Usually part of a training program
 Risk of fractures  Yes (depending on experience & technique)  Yes (depending on experience & technique)
 Dislocation Risk  Minimal (with experience)  Minimal (with experience)
 Blood Loss  Less  Variable
 Muscle Function  Good  Good / Variable
 Recovery after surgery  Faster  Variable depends on patient
 Walking after surgery  3-4 hours after surgery (Dr. Nizam’s ERP        program)  3-4 hours after surgery (Dr. Nizam’s ERP program)
 Hospital Stay  1-2 nights (Dr. Nizam’s ERP program)  1-2 nights(Dr. Nizam’s ERP program)
 Inpatient Rehab  Not required  Not required
 Stair climbing  Next day after surgery  Next Day after surgery
 Driving  4-12 days after surgery  4-8 weeks after surgery
 Long term outcome  Good (special centers)  Good

Does Bikini Hip Replacement give good Access/Exposure?

Yes, Despite the size of the incision, there is good exposure of the acetabulum (Cup) and the Proximal Femur, enabling good access to the hip joint.
Dr. Nizam Designed specialized instruments and equipment to enable this process to make it less invasive and visualize al parts of the hip that are important during surgery to get the best outcome and component positioning.

Preparing for Surgery:

The Surgical procedure, Outcomes, the Post operative period and precautions, Risks and complications would all be discussed in detail by the surgeon. A booklet detailing the journey to our joint replacement programis also given before surgery for patients to read and understand the procedure.

Minimally Invasive, Muscle Sparing approach to Hip Joint Replacement through a bikini line incision.


Who is suitable for this type of surgery?

After careful diagnosis of a hip problem, surgery may be recommended by the orthopaedic surgeon. Most patients may be suitable for the "Bikini" approach; Dr Nizam will discuss your suitability for this technique in your consultation.

What Prosthesis are commonly used?

Depending on the type of hip surgery you require, there are two main types of prosthesis used. The hip joint, a ball and socket, requires both parts, the acetabulum and the femoral components to be replaced.

  1. Acetabulum: This involves replacing the worn socket,or acetabulum, with a prosthesis that has a durable surface; these are often made from ceramic or plastic. This is referred to as the Acetabular component.
  1. Femoral Component: This involves replacing the ball,or head of the femur. Using a stem which is inserted into the middle of the femur and topped with a ball, just like the joint it is replacing.This component may be cemented or un-cemented depending on many factors including age, bone density.The replacement stem is generally made from metal or ceramic. This is referred to as the Femoral component.

Metal-on-Metal Implants?

Dr. Nizam does NOT use metal-on-metal Total hip replacements. We do however still use the Birmingham hip resurfacing which is one of the most successful prosthesis.

Will an Anaesthetist be required?

Most patients have a spinal anaesthetic and a light general anaesthetic.As some patients prefer to be awake during the surgery, pleasefeel free to discuss with the anaesthetist as to how ‘awake’you want to be; we can most often meet the needs of our OzOrthopaedic patients.
This service will be provided by our experienced anaesthetic group. The anaesthetist’s fee will be invoiced separately to the surgeon and hospital fee. The anaesthetist will be in touch prior to the procedure date to inform you of their costs.

What is the Rapid Recovery Program with Pain Management in Joint replacements?

Dr Nizam and his team have a holistic approach to surgery, they don’t just treat the operated hip.
Part One:Before the patient undergoes surgery, we make sure the pain fibres are ‘blocked’ through many means during pre-anaesthesia or before anaesthesia begins. This way patients feel very comfortable and almost pain free after surgery. This means in most cases you will be easily mobile after surgery.

Part Two: A local injection containing a special anaestheticcocktail and other agents is made into the operative site at the time of surgery. As this numbs thearea, once the surgery is completed patients generally feel little, if any, significant pain. Dr Nizam will discuss the details of this during your consultation.

This rapid recovery approach enables patients to walk within three to four hours after joint replacement with less pain, less discomfort, less nausea/vomiting, less muscle weakness and rapid recovery.

In most cases, patients will be discharged home the following day after a Hipreplacement surgery, with many just requiring crutches. Some patients may stay longer or go to rehabilitation when necessary.

Dr. Nizam worked withProfessor L. Kohan and Dr. D. Kerr for over six years in Sydney. This team of Sydney surgeons pioneered this form of pain management and early mobilization regime over 19 years ago with very succesful outcomes.

How soon after hip replacement surgery will I resume walking and taking part in daily activities?

The rapid recovery approach enables patients to walk within three to four hours after joint replacement with less pain, less discomfort, less nausea/vomiting, less muscle weakness and rapid recovery.

Patients are encouraged to wear their own clothing the night of surgery ensuring they are ‘street ready’, up and around and walking.

Will I need wound drains or catheters?

Dr. Nizam does not routinely use drains and catheters as he feels these may increase the risk of infection; by not using them mobilisation is easier and improved.

What should I expect after Joint Replacement Surgery?

Each patient is treated as an individual with age, physiological status, health and patient attitudes considered.

The first four to seven days:

  • Swelling: Is common after any lower limb surgery, the extent and distribution may vary and will decrease with time.OzOrthopaedics encourages walking and muscle activity as this will reduce swelling.
  • Bruising: Bruising may be seen between the thigh and foot depending on the site of the operation;this will also resolve with time and activity.
    Cramps or muscle soreness: Muscle soreness or cramps may be experienced by patients after surgery and this is commonly due to manipulations of the limb during surgery.

When can I resume driving?

Depending on the complexity of surgery, patients can drive as early as from within one to two weeks after joint replacement surgery (individual results may vary).

You may be interested to read our published paper that show results of patients of anterior hip replacement surgery - almost 14% of patients were driving within the first week after surgery, over 50% were driving within the second week and almost 75% driving by the third week.  Early Resumption of Driving within 3 weeks following patient-specific instrumented total knee arthroplasty: an evaluation of 160 cases. I. Nizam, A Batra, S. Gogos. BMJ Journals - JISAKOS 28 Mar 2019. doi: 10.1136/jisakos-2018-000268.

Should I sleep in a particular position?

Patients can sleep on their side or back, depending on comfort as soon as the next day.The only restriction being to not to extend the leg with the toes pointing outwards (hip extension with external rotation).
When can I resume having sex:
This can be commenced almost as soon as comfort and confidence allow.

Will I have a scar?

Scarring is a natural process following surgery. The length of the scar can depend on the extent of surgical incision, skin type, skin colour and other patient factors such as diabetes or skin conditions.Regular massage on healed scars using cream/lotion can help. Silicon gel sheets(on healed wounds) like Gel Mate can also be used to soften and flatten a scar.

What are the complications of joint surgery?

These include general complications of anaesthesia and surgery.
Specific complications with any joint replacement surgery include risk of infection, bleeding, instability/dislocation, limb length discrepancy, blood clots, prosthetic loosening, stiffness, nerve/vessel damage. Other risks of surgery will be discussed by Dr. Nizam before any surgery is to be undertaken.