In hip prosthetic surgery, the minimally invasive anterior approach using the bikini technique offers numerous advantages over traditional surgery. Indeed, it is a minimally invasive methodology that combines advanced medical technology with a surgical approach geared towards the patient’s well-being. ‘Scars that are increasingly smaller and easier to hide by the undergarment are now a major advantage for patients undergoing hip replacement surgery. The advantages of the bikini technique, however, are numerous and are not reduced to a purely aesthetic issue,’ says Dr Walter Salustri, an orthopaedic surgeon and expert in hip and knee surgery who, in the course of his career, has performed more than 600 hip prosthesis operations, operating in facilities of excellence throughout Italy, such as the Policlinico San Donato in Milan, Villa Salaria Hospital in Rome, and the Di Lorenzo Clinic in Avezzano.
by Roberta Imbimbo
Dr Salustri, what does hip replacement surgery using the minimally invasive anterior bikini technique involve?
It is a highly innovative and truly minimally invasive operating technique, which aims to minimise aesthetic impact and improve post-operative recovery. It is so called because the skin cut is performed obliquely along the natural fold of the groin and no longer longitudinally, thus making the scar (only a few centimetres long) less visible than in traditional approaches, also because it is completely hidden by the underwear or swimming costume.
What advantages does this method offer patients over traditional approaches, also in terms of recovery and post-operative pain? Which muscle and tendon structures are involved?
Smaller and less visible incisions reduce the aesthetic and psychological impact, and speed up the healing process. In addition to these aesthetic advantages, bikini incision has other advantages over traditional prosthetic implantation techniques. As mentioned, it is a technique that allows the sparing of subcutaneous soft tissue: the preservation of muscles and anatomical structures improves the stability of the hip and allows a much faster and less painful post-operative recovery. The advantages can be summarised as follows: surgery, hospitalisation, rehabilitation and recovery times are shorter than with traditional techniques; less blood loss during the operation; no pain and less swelling; no need for stitches; fewer post-operative complications such as infections or dislocations. These advantages speed up the patient’s recovery as much as possible. The patient can be discharged on the second day, can wear trousers and shoes immediately, can cross his legs from the day of the operation, and can return to driving after 15 days. The patient will therefore not lose his autonomy and will not need assistance, as he is immediately self-sufficient.
For whom is this method indicated?
This technique can be applied to all persons, without restrictions of gender or weight, both in cases of femoral neck fracture and in cases of hip arthrosis, when the cartilage is severely compromised and causes chronic pain, stiffness and high functional limitations, or when the quality of life has significantly deteriorated; the less visible scar and less invasiveness also make it particularly suitable for young and active patients, who obviously have high functional and aesthetic expectations, and more generally for persons who want a quick recovery to return to an active lifestyle.
What are the risks associated with it?
The risks associated with the bikini technique are much lower than with traditional approaches, but there are nevertheless some potential complications to consider, which are typical of any surgery: the possibility of infection and the risk of dislocation, for example, although they are minimal compared to traditional approaches, are not completely zero. Obviously, the success of the technique depends largely on the surgeon’s competence and familiarity with this particular technique. Among other things, today it is possible to perform hip replacements of the latest generation, as there are highly advanced prostheses on the market, specially designed for the anterior route and made of highly innovative materials (the ceramic head, the polyethylene insert, which have excellent wear resistance and unlimited biocompatibility; while the stem and acetabulum are made of titanium). In conclusion, considering that over 600,000 hip replacements are performed each year worldwide, having a minimally invasive surgical technique available today with potentially fewer post-operative complications is certainly an advantageous and innovative option that can improve patients’ quality of life.
