Anterior Bikini Total Hip Replacement
Bikini Anterior Hip Replacement
(Groin crease / bikini line incision)
The bikini hip replacement is minimally invasive Anterior Hip Replacement technique that is soft-tissue sparing and vessel sparing (preserving lateral circumflex blood vessels) compared to the standard incision anterior hip replacement scar. It has an aesthetically pleasing cosmetic scar along the natural "Langhers lines" of the skin - that can be hidden under the "bikini" or underwear.
Bikini Hip Replacement Scar at 4 weeks
Bikini hip replacement Scar at 2 weeks
Dr. Nizam is an International Surgical Educator and Teacher of Anterior / Bikini hip replacement techniques to surgeons around the world.
He designed the Bikini Hip Replacement Technique - (Published & presented in international meetings) . This Anterior Hip Replacement technique is minimally invasive and soft-tissue sparing and vessel sparing (preserving lateral circumflex blood vessels) compared to the standard incision anterior hip replacement.
He is a high volume Anterior Hip (Fellowship Trained in Anterior Hip Replacement) surgeon and one of the most experienced Bikini Hip Replacement surgeons in Australia.
He performs the large majority of anterior hip replacements through this approach so patients can recover rapidly with less pain and return to normal activities sooner with hardly any limitations.
2 week Scar After
Bikini Hip Replacement
4 week Scar After
Bikini Hip Replacement
6 week Scar After
Bikini Hip Replacement
8 week Scar After
Bikini Hip Replacement
Anterior Hip Replacement Surgery Advantages Include:
- Less post-operative pain, which is improved further with our Enhanced Recovery Program
- Less pain as muscles are not cut
- Less Blood Loss
- Less muscle weakness
- Early mobilisation (as early as 4 hours after surgery in some cases)
- Rapid recovery
- Hidden scar in the groin
- Less risk of dislocations
- Early discharge home
- Drive within weeks after surgery
Images and Videos of Patients after Bikini Anterior Total Hip Replacement
Scar few weeks Surgery Left Hip
Active Flexion over 100 degrees Post Op
6 weeks after bikini hip replacement surgery
Active movement 2 weeks after Bikini Hip Replacement
Patient with a limp prior to treatment, now walking with no limp 2 weeks after bikini hip replacement
Anterior hip replacement surgery: The groin crease or bikini line incision?
It is different to the standard Anterior Approach Hip Replacement as it is a more soft tissue and vessel preserving technique as described in the literature above.
For more details please ask Dr. Nizam at consultation.
Anterior bikini hip replacement: Who is suitable?
The main indications for anterior hip surgery are significant degenerative arthritis (primary or secondary) or inflammatory process (rheumatoid) affecting the hip joint and resulting in increased pain, reduced mobility and function. It can also be performed for fractured hips in some cases.
This approach can be applied to almost all patients requiring anterior hip replacements except those who are very obese or very muscular, which can make the surgery technically difficult even in the most experienced hands. Anterior hip surgery can also be difficult to perform in cases of complex revision surgery where a traditional hip treatment is better.
Anterior Hip Surgery – What is it?:
This approach is an anterior minimally invasive hip replacement. It includes a mini incision into muscle sparing (inter-muscular and inter-nervous plane) – which acts to preserve muscles and tendons. In other words no muscles or tendons are cut and repaired later.
Anterior hip surgery has been carried out in Europe for several decades and has produced and excellent success rate. The incision is smaller than the traditional posterior/lateral or anterolateral approaches and the muscles are preserved.
Anterior total hip replacement: Is a traction table used?
Dr. Nizam Does NOT use a traction table to when operating on the hip, he uses a standard operating table with special instrumentation. There are advantages and disadvantages with and without traction tables which can be discussed with your specialist at consultation.
Is Anterior Hip Replacement the Best?
No one can claim that anterior hip replacement is the best. There are advantages and disadvantages between different approaches and Dr. Nizam was trained in all methods, allowing him to make a qualified choice on the best procedure.
The Facts: Standard Posterior VS Anterior Total Hip Replacement:
|Anterior Approach||Posterior Approach|
|Patient position||Supine (on your back)||Lateral (on your side)|
|Traction Table to distract hip||Usually Used (Dr. Nizam does not use a traction table)||Not Used|
|Incision Site||Usually along the front of the thigh (Dr. Nizam uses bikini line incision for bikini hip replacement)||On the side of the hip|
|Incision length||7-11cm (variable)||9-15cm (variable)|
|Minimally Invasive hip replacement surgery||Yes – Applicable||Yes – Applicable|
|Exceptions||In Obese, Muscular patients and Revision hip surgery||Generally allows easy access and is the most commonly used|
|Muscle Preservation||Mostly (except sometimes surgeon release piriformis muscle)||Gluteus muscle is split (not cut) and short external rotator (tendons) are cut then repaired – NO muscles are cut.|
|Risk of Nerve Damage||Risk of injury to lateral femoral cutaneous to thigh (8-40%) but no functional limitations||Usually none, but very small risk to sciatic nerve|
|Special Training||Yes but can be part of training program||Usually part of a training program|
|Risk of fractures||Yes (depending on experience & technique)||Yes (depending on experience & technique)|
|Dislocation Risk||Minimal (with experience)||Minimal (with experience)|
|Muscle Function||Good||Good / Variable|
|Recovery after surgery||Faster||Variable depends on patient|
|Walking after surgery||3-4 hours after surgery (Dr. Nizam’s ERP program)||3-4 hours after surgery (Dr. Nizam’s ERP program)|
|Hospital Stay||1-2 nights (Dr. Nizam’s ERP program)||1-2 nights(Dr. Nizam’s ERP program)|
|Inpatient Rehab||Not required||Not required|
|Stair climbing||Next day after surgery||Next Day after surgery|
|Driving||8-14 days after surgery||4-8 weeks after surgery|
|Long term outcome||Good (special centers)||Good|
Anterior hip surgery: Does it give good access/exposure?
Yes, despite the size of the incision, there is good exposure of the acetabulum (cup) and the Proximal Femur, enabling excellent access to the hip joint.
You will have ample opportunity to thoroughly discuss all areas of treatment with your surgeon, including: preparation for surgery, the surgical procedure, outcomes, the post-operative period and precautions, risks and complications that you may encounter.
- Femur (thigh Bone) and Acetabulum (Cup) is prepared – (Reaming)
- Prosthesis inserted
- Xray Appearance
- The Neck is resected after hip joint is exposed
Who is suitable for this type of anterior hip replacement surgery?
Surgery is usually recommended only after careful diagnosis of a hip problem, including severity of pain, lack of mobility and/or function. The majority of patients could be performed through the minimally invasive anterior hip replacement approach. Details can be discussed by appointment with Dr. Nizam.
Acetabulum : This involves replacing the worn socket, known as acetabulum, with a component with durable bearing surfaces (ceramic or plastic).
Femoral Component : The ball, often metal or ceramic, replaces the worn head of the thigh bone (femur) with a stem inserted into the middle of femur. This component could be cemented or un-cemented depending on many factors including age and bone density.
There is much debate and concern among the orthopaedic community and the media about metal-on-metal bearing surfaces. Metal-on-metal articulations have been around for many decades and have been used for successful outcomes since 1938. However, with recent concerns of high metal ion levels (chrome and cobalt) and the associated adverse reactions to metallic debris in this type of prosthesis, most surgeons have moved away from this method for anterior total hip replacement.
Dr. Nizam does NOT use metal-on-metal for anterior hip surgery. We do however still use the Birmingham hip resurfacing which is one of the most successful prosthesis. To date over 140,000 Birmingham hip resurfacings have been performed world-wide. One study reported that over 90% of the resurfaced patients returned to sporting activities, 60% without detriment to their hips. The failed metal-on-metal implant which has been put in the spotlight for high failure rates is ASR prosthesis. Dr. Nizam has not used them in any patients.
This service will be provided by an experienced anaesthetist who will discuss your anaesthetic and pain management during and after surgery. They will see you prior to surgery and it is very important that you bring along your partner, family member or a friend for this consultation.
A further detailed information booklet will be provided by Dr. Nizam to his patients undergoing specific surgical procedures. The booklet will outline pre-operative preparation, instructions, details of the surgery, post-operative outcomes, rehab requirements and a range of surgical risks and complications for anterior hip replacement surgery.
Our Enhanced Recovery Program with Pain Management (LIA) in Joint replacements:
The first step involves injecting local anaesthetic into the operative site at the time of anterior hip surgery. This actively numbs that part so that after surgery patients won’t feel any significant pain or major discomfort. The details of this will be discussed at a consultation.
This will enable patients to walk within 3 to 4 hours after anterior hip replacement with less pain, discomfort, less nausea/vomiting, less muscle weakness and putting them on track to rapid recovery.
In the majority of cases, patients will be discharged home the following day after bikini hip replacement with crutches. Dr. Nizam worked closely with the pioneering team in Sydney responsible for developing the process of giving patients rapid recovery.
Walking and Activities of Daily Living
Most patients are usually walking in 3 to 4 hours when using our pain management program. Patients are encouraged to wear their own clothing the night of surgery. We recommend you resume regular daily activities as soon as comfort and confidence returns after anterior total hip replacement.
Wound drains &catheter tubing: Dr. Nizam does not routinely use drains and catheters as this may increase risk of transfusion and infection, but more importantly slows down mobilization.
What to expect after anterior bikini hip replacement surgery
Each patient is treated as an individual with age, physiological status, health and patient attitudes considered. Those who are extremely motivated will achieve the best recovery results.
The first 4-7 days:
- Swelling: Is very common after any lower limb surgery. This is variable in extent and distribution. But this decreases with time. We encourage walking and muscle activity as this will diminish swelling.
- Bruising / Muscle pain/Cramps: Bruising may be seen between thigh and foot levels depending on the operated site. This will also resolve with time. Muscle soreness or cramps may be experienced by patients after surgery and this is commonly due to manipulations of the limb during surgery.
Driving: Depending on the complexity of surgery, patients can drive as early as 1-4 weeks after anterior hip replacement surgery (individual results may vary).
Flying after a bikini hip replacement For short interstate flights, you can fly after 7 days. For long interstate journeys and flights over 5 hours, the recommendation is 6 weeks post-surgery, as patients are at an increased risk of blood clots. Make sure you advise Dr. Nizam if you intend to fly during this time. You should wear thigh high TED stockings, take aspirin 3 days before, during and after the flight, do foot and ankle exercises during the flight and have a short walk on the plane if possible. It’s absolutely crucial to stay well hydrated. If you have a previous history of DVT or PE, we need to know so that we can provide safe care.
Airport Security after anterior hip replacement Metal detectors at the airport security gates can beep with your knee or hip replacements. Unfortunately there are no ID cards or letters that would be accepted by any security staff. Patience will help you through these instances.
Sleeping: Patients are able to sleep on the side or back. You will be instructed on the most ideal sleeping positions, with the only restriction, post-anterior hip surgery, being not to extend the leg with the toes pointing outwards, which can cause hip extension.
Sex: This can be commenced almost as soon as comfort and confidence allows and depends entirely on how fast the individual patient recovers from their hip replacement.
A scar is a natural process following surgery or injury. A scar will depend on the extent of surgical incision, skin type, skin colour and other patient factors such as diabetes or skin conditions.
Regular massage on healed scars using creams and lotions can help. Silicone gel sheets applied to healed wounds like Gel Mate can also be used to soften and flatten a scar.Complications of Joint Surgery
Complications of Joint Surgery:
These include general complications of anaesthesia and surgery.
Specific complications with any joint replacement surgery include risk of infection, bleeding, instability, dislocation, limb length discrepancy, blood clots, prosthetic loosening, and stiffness, nerve and vessel damage. Other risks of surgery will be discussed by Dr. Nizam before any anterior total hip replacement surgery is undertaken.
Questions to ask a Specialist Anterior Hip Replacement Surgeon:
- Am I a suitable candidate for Anterior hip replacement?
Mr. Nizam does almost all hip replacements through the bikini anterior hip replacement method.
- What is the success rate of Anterior hip Replacement over another approach?
Mr. Nizam has done one of the largest series in Australia and does many research studies. He has excellent outcomes thus far.
- What are the advantages or disadvantages of Anterior hip Replacement?
The major advantages are: less pain, rapid recovery with minimal limitations and early discharge home with early return to normal function. The disadvantage being that patients don’t feel they have had major surgery so they do more than what they are supposed to - so they should ease off at times – guided by the surgeon.
- How many of these procedures, has the surgeon done?
Mr. Nizam has been involved in over 1000 anterior hip replacements of which he has performed upto 700 bikini anterior hip replacements.
- Has the surgeon had fellowship training in Anterior Hip Replacement?
Mr. Nizam has extensive fellowship training in Sydney and overseas in this technique. He has published on the surgical technique – Bikini Hip Replacement– preserving vessels/nerves : It is important that surgeons are trained well in this technique before embarking on anterior hip replacements.
- What prosthesis is used? And how successful are the prostheses?
Mr. Nizam uses the so-called “VeriLast” Technology with oxinium (oxidized zirconium) and poly- ethylene bearing which is very successful in hip replacements. We do not use metal on metal total hip implants.
- What kind of anaesthetic am I having?
Mr. Nizam has done extensive research and publications in Enhanced Recovery Programs and worked with Professor Kohan and Dennis Kerr and uses a combination of spinal anaesthesia and light sedation to improve mobility afterwards.
- Do I need Pre-operative medical assessment?
This is very important to make sure we do not miss any medical issues that patients may be unaware of. This will be determined by the pre operative screening that will take place.
- What are the basic steps in Anterior Hip Replacement ?
Are Muscles or tendons cut? There is a video on this website which explains how the muscles are NOT cut but split between to enter the hip joint. Hence less pain and quicker recovery
- Is a Traction table used?
What are its advantages and disadvantages? Mr. Nizam doesn’t use a traction table as its easier to do it on a standard table and avoids complications associated with a traction table.
- Are Xrays Used during Anterior Hip Replacement Surgery?
Mr. Nizam does NOT use Xrays as he is confident where the components are appropriately placed especially the cup orientation. Xrays can be time consuming and can expose the patient and staff to radiation. Mr. Nizam also designed alignment tools for accurate cup placement, which he uses during bikini anterior hip replacement.
- How does the surgeon ensure correct leg lengths during surgery in Anterior Hip Replacement?
Since Mr. Nizam doesn’t use a traction table, its much easier to assess leg lengths at the bottom of the table, checking ankle and knee positions keeping and assess stability of the hip as well.
- What are the risks of dislocations in Anterior Hip Replacement?
The risks of dislocations are smaller with this approach as no muscles or tendons are cut. As long as the component positions are well placed and the patients follow the surgeon’s instructions, they will be fine.
- What are the expected complications of tAnterior Hip Replacement?
This is detailed in the website however, there are always risks such as infection, bleeding, blood clots, neurological issues, fracture, dislocations, medical problems that will be discussed before surgery. We try to keep it very minimal as long as the patient follows the instructions after surgery.
- What is the risk of thigh numbness after Anterior Hip Replacement?
This is very small due to tiny skin branches of the lateral femoral cutaneous branches. Majority of this recovers overtime. This is NOT the femoral nerve as we do not enter this territory in anterior bikini hip replacement.
- Will I have any wound drain tubes?
Mr. Nizam has never used drain tubes as we do not envisage any bleeding.
- How long is the incision and can you see any pictures of the incisions in Anterior Hip Replacement ?
The bikini incision is 6-7cm long over the lateral groin crease.
- How soon am I walking after Anterior Hip Replacement ? Hours or days?
Mr. Nizam's patients usually walk a few hours after surgery with this technique and enhanced recovery program.
- Will I have much pain and muscle weakness after surgery?
There is usually not much in the way of pain or weakness and most patients are ambulating using a crutch or 2 after surgery and depending on the patient after a few days or 1-2 weeks the crutches can be discarded.
- What pain meds do I take when I go home after Anterior Hip Replacement ?
There will be a detailed list given. Usually regular panadol with or without some anti-inflammatory (unless allergic or medical issues) Other pain meds will be discussed.
- How much swelling and bruising do I expect and how long for?
There is usually only minimal swelling post surgery but this can vary from patient to patient depending on the complexity of anterior hip replacement.
- When can I go home after Anterior Hip Replacement ?
Mr. Nizam's patient usually can go hom within 24-48 hours post op. But patients living alone are usually sent to rehab to be on the safe side.
- Is rehab necessary after anterior hip replacement?
Not usually unless living home alone or there are other rehab requirements determined by our physiotherapists.
- Are there any activity limitations after anterior hip replacement?
If so what are they? Usually there are minimal limitations and this can be discussed with Mr. Nizam. Usually, avoid combined extension and external rotation of that leg for 6 weeks.
- When can I get rid of crutches and walk independently after anterior hip replacement?
This can be between days to weeks depending on confidence and comfort. Some patients only use it for 1-2 days, others upto 2 weeks.
- What precautions do I take to prevent blood clots?
To make sure you move your limbs, drink plenty of fluids, exercise regularly, follow the post op orders and wear the TED stockings for the relevant period.
- When can I drive after anterior hip replacement ? When can I sleep on my side?
Mr. Nizam has done one of the largest studies which revealed that 75% are already driving within 3 weeks irrespective of the side of the hip operated on. 15% are actually driving within 1 week. Mr. Nizam will discuss this in detail and it all boils down to confidence, comfort and not on narcotic analgesia before driving. You can sleep on the side of surgery when ever you want.
- When Can I fly after anterior hip replacement?
For short flights less than 3 hours you can fly after 7 days. For flights over 5 hours, the recommendation is 6 weeks after operation.
- Will I set off the Alarm at Airport Security?
Most likely, yes, as the metal components in the hip or knee would set off the very sensitive metal detectors. You have to inform airport security early and be patient.