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Skin Crease ‘Bikini' Incision for Anterior Approach THR: Anatomical Considerations and Avoidance of Complications

February 01, 2014

Contributors: Nicola Rusca; Michael Leunig, PhD; Michael Leunig, PhD

Minimally invasive total hip replacement (THR) has gained recent popularity, and the direct anterior approach (DAA) is commonly used. Advantages of the DAA include limited muscular disuse, improved joint stability, a simple postoperative regimen, and cosmetic benefits. Indications for THR include neuropathic disease because risk for dislocation is reduced. Another option is simultaneous bilateral THR, which minimizes soft-tissue trauma and the postoperative regimen. Nevertheless, concerns are associated with this approach because it is technically demanding and the learning curve is substantial. It is also associated with use of intraoperative fluoroscopy and a fracture table. This video presents the rationale for the direct anterior approach without a fracture table and describes an anatomic step-by-step dissection performed on a cadaveric specimen that includes tips on how to avoid surgical complications. We used a short oblique skin incision centered in the groin cleavage line, also called the “bikini incision.”

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