Direct Anterior Approach for Total Hip Arthroplasty by “Bikini Incision”

Background:The direct anterior approach (DAA) for total hip arthroplasty (THA) is getting increasingly popular due to its muscle-sparing characteristics and the advantages related to minimally invasive surgery.The "bikini incision, " is an esthetically modified incision for DAA that aligns with the groin crease without compromising surgical exposure.Objective: This article describes the surgical technique of the bikini incision for DAA, discusses its advantages and limitations, and summarizes current evidence on clinical outcomes.Materials and methods: A detailed description of the incision, operative technique, including the acetabular exposure, femoral mobilization, and its preparation, is described in detail.Recent literature comparing bikini incision to conventional DAA incision is reviewed to assess its efficacy and patient satisfaction. Results:The bikini incision provides equivalent surgical access and implant positioning accuracy compared to the conventional incision for DAA.The reported outcomes demonstrated better satisfaction with improved cosmesis but comparable complication rates and recovery profiles. Conclusion:The bikini incision represents a safe and effective modification of the DAA for THA, with better cosmetic results.However, the risk of lateral femoral cutaneous nerve (LFCN) injury and the challenges of limited exposure when extension is required are its limitations.