The Anterior Hip Replacement Bikini Incision – Not just for the French Riviera

We’ve shared information about the benefits of anterior hip replacements including a low dislocation rate, improved control of component positioning, and an easier and less complicated recovery. However, not everyone is familiar with the different incisions associated with the surgery.

Traditionally the incision runs from just below and outside your front hip bone (the anterior superior iliac spine) and down the thigh for approximately 8-10 cm. This allows excellent visibility of the hip joint in between two muscles (the Sartorius and the tensor fascia lata).

A bikini incision gives access to the same space in between the muscles – but the incision follows the skin crease at the top of the thigh.

Dr. Mast has extensive experience with the bikini incision – having first experiences it during his fellowship in Paris, France in 2008 under Prof. Frederic Laude – a pioneer in anterior hip surgeries.

At the time,  referred to it as the “hip for the French Riviera” as many of his patients would opt to recover in the south of France at the time and they wanted a less noticeable incision. But interestingly, Prof. Laude also used this incision for patients – for example, obese patients or those with skin folds- where the healing process for a standard incision would be more challenging. (Read more about the benefits of an anterior approach for patients with a high BMI here)

This is to a large extent due to the bikini incision following Langer’s Lines. These skin tension lines correspond to the natural orientation of collagen fibers in the skin and usually lie parallel to underlying muscle fibers. When incisions are made in the direction of Langer’s lines they tend to heal better and produce less scarring than those that cross the lines.

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This patient had both hips operated on by Dr. Mast at different times. The left hip was replaced via a traditional incision, while the right hip had a bikini incision. She never fails to remind him which scar she prefers…..

Since approximately 2017, the majority of patients in Dr. Mast’s practice have received bikini incisions. The incision for a standard approach tends to be a little shorter, however, the bikini incision tends to give a cosmetically better outcome.

If you have a preference, this is a topic to bring up at your consultation!

Nicholas Mast MD is a board-certified orthopedic surgeon specializing in conditions of the hip and pelvis.

Trained in pelvic and acetabular trauma and reconstruction by some of the best in the field, his treatments range from non-replacement options for the management of hip osteoarthritis to complex revision surgeries and hip preservation techniques including periacetabular osteotomy.

He is the most experienced surgeon in the region in the use of the anterior approach for hip replacement and regularly uses this minimally invasive, fast recovery anterior approach to treat a wide variety of hip conditions.