Safety and outcomes of bikini-incision DAA for hip arthroplasty with large acetabular cups (≥56 mm): A single-surgeon series of 215 cases

Introduction: This study evaluates complications associated with the bikini-incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon on a standard operating table, with a focus on cases requiring large acetabular cups (≥56 mm). Secondary objectives include assessing clinical outcomes and implant survivorship. Methods: A retrospective analysis was conducted on primary bikini-incision DAA THAs performed by a single surgeon between 2013 and 2024. Cases involving acetabular cups ≥56 mm were included, while emergency hip fracture cases and those requiring posterolateral approaches were excluded. Clinical data, radiographs, and Kaplan-Meier survival analysis were used to assess complications, Harris Hip Scores (HHS), and implant survivorship. Results: This study included 215 THA procedures performed on 210 male patients (mean age 67 years, BMI 28.6), with an average follow-up of 3.9 years. The primary indication was osteoarthritis (88.4%). The mean preoperative HHS was 41.8, which significantly improved to 92.6 postoperatively (p < 0.001). Complications included lateral femoral cutaneous nerve (LFCN) neuropraxia (2.3%), periprosthetic fractures (0.93%), and femoral stem subsidence (0.93%). The revision rate was 0.93%, with Kaplan-Meier analysis indicating a 99% survival rate for the stem and 100% survival for the acetabular cup at the final follow-up. Discussion: The bikini-incision DAA THA using a standard operating table provides excellent short- to mid-term functional outcomes and implant survivorship for patients requiring large acetabular cups (≥56 mm). The approach is associated with low complication and revision rates, supporting its safety and efficacy in this cohort.