Abstract
Conventional incision orientation for direct anterior approach (DAA) total hip arthroplasty
(THA) is longitudinal, paralleling fibers of the tensor fascia latae. Alternatively,
a “bikini” incision can be oriented along Langer's lines. We sought to determine if
there were any differences in surgical site complications (SSCs), mechanical complications,
or reoperation between longitudinal and bikini DAA. We retrospectively reviewed 420
consecutive primary DAA THA by a single surgeon over a 2-year period. The surgeon
was experienced with both incision orientations. Complications were recorded by chart
review. Chi-square tests were used to examine for differences between categorical
variables and t-tests for continuous variables. Longitudinal incisions were used in 320 patients
(76.2%) while bikini incisions were used in 100 patients (23.8%). Women were significantly
more likely to have a bikini incision (39.1% vs. 5.8%; p < 0.00001). Across the entire cohort, patients undergoing THA through either longitudinal
or bikini incision had comparable rates of SSCs (4.7% vs. 5.0%; p = 0.90). With longitudinal incisions, SSCs were more likely to occur in obese patients
compared with nonobese patients (8.3% vs. 3.1%; p = 0.04). With bikini incisions, there was no difference in the rate of SSCs between
obese and nonobese patients (4.0% vs. 5.3%; p = 0.79). There were no differences in mechanical complications or rates of reoperation
(0.3% vs. 0.0%; p = 0.58). Both longitudinal and bikini incisions are safe and effective ways to perform
the DAA for primary THA, with no differences in rates of SSCs, mechanical complications,
or reoperation. For obese patients in this series, the bikini incision was associated
with a lower rate of SSCs but requires future study due to dissimilar study groups.
Keywords
total hip arthroplasty - direct anterior approach - bikini incision - longitudinal
incision - wound complications - mechanical complications
