Anterior Bikini Total Hip Replacement


  • Standard Anterior Hip Replacement Cut
    Bikini Anterior Hip Replacement
  • New Bikini Cut
    (Groin crease / bikini line incision)

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
    2 week Scar After
    Bikini Hip Replacement
  • 4 Week scar after bikini hip replacement
    4 week Scar After
    Bikini Hip Replacement
  • 6 Week scar after bikini hip replacement
    6 week Scar After
    Bikini Hip Replacement
  • 8 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
    Scar few weeks Surgery Left Hip
  • Active Flexion over 100 degrees Post Op
    Active Flexion over 100 degrees Post Op
  • 6 weeks Post Surgery Bikini Hip Replacement
    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?

The Bikini Anterior Hip Replacement is a technique described by Dr. Nizam and is published.

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)
Blood Loss Less Variable
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.

  • Bikini Hip Replacement
  • scar-few-weeks-surgery-left-hip
  • active-flexion
  • Anterior Hip Replacement
  • Anterior Hip Replacement
  • Anterior Minimally Invasive
  • X-ray
  • Femur (thigh Bone) and Acetabulum (Cup) is prepared – (Reaming) Femur (thigh Bone) and Acetabulum (Cup) is prepared – (Reaming)
  • Prosthesis inserted Prosthesis inserted
  • Xray Appearance

    Xray Appearance
  • The Neck is resected after hip joint is exposed

    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.

Metal-on-Metal Implants?

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.

Further information:

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 replacementMetal 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.

Scar Management:

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:

  1. Am I a suitable candidate for this procedure?
  2. What is the success rate of this approach over another approach
  3. What are the advantages or disadvantages of this procedure
  4. How many of these procedures, has the surgeon done?
  5. Has the surgeon had fellowship training in this approach
  6. What prosthesis is used? And how successful are the prostheses?
  7. What kind of anaesthetic am I having?
  8. Do I need Pre-operative medical assessment?
  9. What are the basic steps in the procedure? Are Muscles or tendons cut?
  10. Is a Traction table used? What are its advantages and disadvantages?
  11. How does the surgeon ensure correct leg lengths during surgery?
  12. What are the risks of dislocations?
  13. What are the expected complications of this kind of surgery?
  14. What is the risk of thigh numbness after surgery?
  15. Will I have any wound drain tubes?
  16. How long is the incision and can you see any pictures of the incisions?
  17. How soon am I walking after surgery? Hours or days?
  18. Will I have much pain and muscle weakness after surgery?
  19. What pain meds do I take when I go home?
  20. How much swelling and bruising do I expect and how long for?
  21. When can I go home after surgery?
  22. Is rehab necessary?
  23. Are there any activity limitations? If so what are they?
  24. When can I get rid of crutches and walk independently?
  25. What precautions do I take to prevent blood clots?
  26. When can I drive? When can I sleep on my side?
  27. When Can I fly?
  28. Any further Specific Questions: