Bikini versus Traditional Incision in DAA THA: Patient Satisfaction, Surgeon Observation, and LFCN Damage.

Abstract

Background: The bikini incision (BI) used in direct anterior approach total hip arthroplasty (DAA THA) theoretically improves scar aesthetics by utilizing the inguinal crease; however, current literature suggests its transverse orientation increases the risk of injury to the lateral femoral cutaneous nerve (LFCN). This study examines (1) patient and surgeon satisfaction with scar appearance and (2) differences in post-operative LFCN sensation between the vertical, traditional incision (TI) and the BI.

Questions/purposes: In this pilot study, the following questions were investigated: (1) Do BI patients experience increased scar satisfaction compared to TI patients? (2) Does the surgeon report greater satisfaction with BI scars compared to TI scars? (3) Do BI patients have a reduced incidence of LFCN sensory disturbance compared to TI patients?.

Patients and methods: Fifty-five patients (32 TI and 23 BI), at least 6 months post-DAA THA, were recruited from a high-volume, fellowship-trained reconstruction surgeon. 91% of the BI group was female, compared to 50% of the TI group. The Patient and Observer Scar Assessment Scale (POSAS) allowed patients to describe scar appearance and complications (eg, pain and itchiness) and enabled the surgeon to assess vascularity, pigmentation, thickness, relief, pliability, and surface area. Monofilament testing at superomedial, superolateral, inferomedial, and inferolateral quadrants of the anterior thigh assessed LFCN hypoesthesia.

Results: POSAS analysis demonstrated that (1) BI patients were significantly more satisfied with scar appearance than TI patients (p < 0.05), and (2) the surgeon was significantly more satisfied with BI scars than TI scars (p < 0.05). (3) Monofilament testing showed significantly more LFCN impairment in the inferomedial quadrant of the TI group (p < 0.0125).

Conclusion: This study demonstrates improved patient and surgeon satisfaction with the BI. Contrary to current beliefs, the BI better preserves LFCN innervation relative to the TI.