|Beitragstitel||Bikini skin crease incision for direct anterior approach: clinical and radiographic mid-term results|
The direct anterior approach (DAA) has traditionally been performed through a longitudinal incision in line with tensor fascia lata, however, this does not follow anatomic skin cleavage lines, which may result in increased tension at the skin edges, inferior wound healing, poor scar cosmesis, and subjective patient discomfort. The purposes of this study are to describe patient functional outcomes and radiographic outcomes of a modified short oblique “bikini” incision for DAA compared to a traditional longitudinal incision.
964 patients undergoing total hip arthroplasty using DAA (49% male, 51% female; 59% with longitudinal incision, 41% bikini incision) completed 2 to 4 years after surgery a follow-up questionnaire including the Oxford Hip Score (OHS), the University of North Carolina 4P scar scale (UNC4P), and two items assessing aesthetic appearance and symptoms of numbness. Stem positioning and the rates of radiographic heterotopic ossification were also assessed.
According to the clinical scar score (UNC4P) total score were significantly (p<0.001; effect size 0.2) better in the Bikini [0.2 (SD 0.8)] compared the longitudinal group [0.4 (1.0)]. The patients of both groups were satisfied or very satisfied (about 99%). However, the proportion of very satisfied patients was higher (p<0.001) in the Bikini compared to the longitudinal group. The proportion of patients reporting numbness in the scar was higher (p<0.001) in the longitudinal compared to the Bikini group (14.5 versus 7.5%, respectively). The OHS was higher in the Bikini group than the longitudinal incision group (p=0.013; effect size 0.15). Radiographic cup abduction angles were similar between the Bikini and longitudinal incision groups (Bikini: 41.0 degrees; standard deviation [SD] 5.3 (n=87); Longitudinal: 41.2 degrees; SD 5.0 (n=113); Diff. -0.2 (-1.7 to 1.2), p=0.740). There were no differences in stem position between the two groups (% varus positioning: 11.5% in Bikini versus 9.7% in Longitudinal group; p=0.43). Rates of radiographic heterotopic ossification were not different between the two groups.
The bikini incision resulted in improvements of patient satisfaction in relation to the scar. Our study also showed that a short oblique “bikini” skin crease incision for the DAA could be performed safely without compromising implant positioning or increasing symptoms suggesting lateral femoral cutaneous nerve dysesthesia.