Longitudinal incision vs bikini incision for anterior total hip arthroplasty: A systematic review and meta-analysis from the FP-UCBM Hip Study Group

The direct anterior approach (DAA) for total hip arthroplasty (THA) with two distinct skin incisions has gained popularity due to its muscle-sparing benefits. This systematic review and meta-analysis aimed to compare postoperative outcomes and complications associated with these incisions in DAA THA. A systematic literature search was conducted using PubMed and Scopus to identify studies comparing the bikini and longitudinal incisions in DAA THA. Studies were included if they reported postoperative outcomes, complications such as lateral femoral cutaneous nerve (LFCN) injury, wound healing issues, infections, and functional scores. Meta-analysis was performed using Review Manager (RevMan 5.4), with perioperative outcomes and complications analyzed as mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI). Nine studies comprising 2,292 patients were included. No significant differences were found in clinical outcomes, including Harris Hip Score (HHS) and Oxford Hip Score (OHS) (p > 0.05). LFCN injury rates were comparable between groups (OR 0.92, p = 0.82), and revision rates showed no significant differences (OR 0.58, p = 0.20). While the bikini incision resulted in improved scar aesthetics and slightly shorter hospital stays, it was associated with a potentially higher risk of wound complications. Both bikini and longitudinal incisions demonstrated similar safety and efficacy in DAA THA. The choice of incision should be tailored to patient-specific factors, with further research needed to assess long-term outcomes, including chronic nerve dysfunction and implant longevity.