Anterior Bikini Total Hip Replacement

The Bikini Hip Replacement is a minimally invasive Anterior Hip Replacement Technique that is soft-tissue and vessel sparing (preserving lateral circumflex blood vessels) compared to the standard incision anterior hip replacement approach and its resulting scar. It has a less aesthetically intrusive cosmetic scar along the natural ’Langhers lines’ of the skin, and can be easily hidden under the ’bikini’ or underwear. Compared to a c-section scar, this is much easier for patients to live with.

Dr. Nizam is an international surgical educator and teacher of Anterior/Bikini Hip Replacement techniques to international surgeons. He is a high volume Anterior Hip surgeon and one of the most experienced Bikini Hip Replacement surgeons in Australia. He has undertaken Fellowship Training in Anterior Hip Replacement.

He designed the Bikini Hip Replacement Technique, which has been Published and presented in international meetings. This Anterior Hip Replacement Technique is minimally invasive compared to the standard incision anterior hip replacement.

Dr. Nizam performs the large majority of Anterior Hip Replacements with this approach so patients can recover rapidly and with less pain and return to enjoying their normal activities sooner.

Anterior Hip Replacement Surgery Advantages Include:

Less post-operative pain as muscles are not cut. Pain is further reduced with our Enhanced Recovery Program (ERP)
Less pain
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
Drive within weeks after surgery

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 from the standard Anterior Approach Hip Replacement as it is a technique which preserves more soft tissue and blood vessels (as described above).

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 and reduced mobility and function. The surgery 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, and in this case a traditional hip treatment is better.

Anterior Hip Surgery – What is it?

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 and reduced mobility and function. The surgery 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, and in this case a traditional hip treatment is better.

Anterior total hip replacement: Is a traction table used?

Dr. Nizam Does NOT use a traction table when operating on the hip, he uses a standard operating table with special instrumentation. There are advantages and disadvantages to using 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 approach. 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 according to each patient’s individual circumstances.

The Facts: Standard Posterior VS Anterior Total Hip Replacement:

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 excellent exposure of the acetabulum (cup) and the proximal femur, allowing for optimal access to the hip joint. At Orthopaedic Surgeon, we prioritize thorough discussions between you and your surgeon covering all aspects of treatment, from pre-surgery preparation to the surgical procedure, expected outcomes, post-operative care, precautions, risks, and potential complications that may arise. Your journey towards healing and recovery starts here. Discover the difference with our dedicated care and expertise. Trust our team to guide you every step of the way. Let’s take the next step towards a healthier you. Edit or remove this text inline or in the module Content settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.

Images of Patients after Bikini Anterior Total Hip Replacement:

More Information

Questions to ask a Specialist Anterior Hip Replacement Surgeon

1. Am I a suitable candidate for Anterior hip replacement?
  Mr. Nizam does almost all hip replacements through the bikini anterior hip replacement method.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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
10. 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.
11. 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.
12. 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.
13. 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.
14. 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.
15. 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.
16. Will I have any wound drain tubes?
  Mr. Nizam has never used drain tubes as we do not envisage any bleeding.
17. 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.
18. 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.
19. 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.
20. 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.
21. 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.
22. 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.
23. Is rehab necessary after anterior hip replacement?
  Not usually unless living home alone or there are other rehab requirements determined by our physiotherapists.
24. 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.
25. 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.
26. 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.
27. 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.
28. 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.
29. 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.

Who is suitable for this type of anterior hip replacement surgery?

Metal-on-Metal Implants?

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.

Scar Management:

Complications of Joint Surgery:

Further information:

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