Bikini Anterior Hip Replacement
(Groin crease / bikini line incision)
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.
Please refer to our website : wwww.bikinihipreplacement.com.au
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 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.
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
Scar few weeks Surgery Left Hip
Active Flexion over 100 degrees Post Op
6 weeks after bikini hip replacement surgery
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).
For more details please ask Dr. Nizam at consultation.
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.
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.
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.
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.
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 |
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 any 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
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.
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:
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
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.