What Is a “Bikini Incision” in Anterior Hip Replacement?

Patients considering hip replacement often ask about scar size and placement. One term that comes up frequently—especially online—is the “bikini incision.”

While the name may sound cosmetic, it’s important to understand what this incision actually means, how it relates to the anterior approach to hip replacement, and—most importantly—what truly matters for a successful long-term outcome.

This article breaks it down clearly and honestly.

What Does “Bikini Incision” Mean?

A bikini incision refers to a low, gently curved skin incision used during an anterior (front) approach total hip replacement.

Instead of a straight incision higher on the thigh, the bikini incision is placed along natural skin creases near the groin, where underwear or swimwear often sits. Because of its location and orientation, it may heal with a less noticeable scar for some patients.

It’s important to note:

• The bikini incision is not a different surgery

• It does not involve different implants

• It does not change the mechanics or durability of the hip replacement

It is simply a variation in skin incision placement used during an anterior approach.

How the Bikini Incision Relates to the Anterior Approach

Hip replacement surgery can be performed through several approaches, defined by how the surgeon accesses the hip joint.

The anterior approach reaches the hip from the front and works between natural muscle planes, rather than cutting through muscle. The bikini incision is one way—though not the only way—to perform this approach.

Some potential advantages of the anterior approach (when done appropriately) include:

• Muscle-sparing access

• Earlier functional recovery for some patients

• Lower dislocation risk in certain studies

However, the incision itself is only one factor. Outcomes are influenced by surgical planning and technique, as well as individual patient factors and healing responses.

What the Bikini Incision Does Not Change

This is where clarity matters.

A bikini incision does not:

• Make the hip replacement stronger

• Make the implant last longer

• Guarantee faster recovery

• Reduce complications on its own

A hip replacement is designed to relieve pain and restore function over time—regardless of where the skin incision is placed.

Scar appearance can matter to patients, and that’s reasonable. But it should never outweigh safety, visualization, or precision during surgery.

Who May Be a Good Candidate?

Not every patient is an ideal candidate for a bikini incision.

The decision depends on multiple factors, including:

• Individual anatomy

• Bone structure

• Muscle and soft-tissue quality

• Body habitus

• Prior hip or abdominal surgeries

• Need for exposure to safely position implants

While a bikini incision can be an excellent option for the right patient, incision placement should never compromise visualization or technique. When greater exposure is needed, a different incision can provide better visualization and flexibility during the procedure.

Why Surgical Decision-Making Matters More Than Scar Placement

The most important factor in hip replacement success isn’t the incision—it’s thoughtful surgical decision-making.

That includes:

• Choosing the right approach for you

• Positioning implants accurately

• Balancing stability and leg length

• Protecting surrounding structures

• Planning for long-term durability

  
  

A discreet scar is a nice benefit, but the focus should always be on how the hip functions over time—not just incision size.

The Bottom Line

A bikini incision can be an excellent option when it aligns with anatomy, safety, and surgical goals. It’s one of many factors that must be individualized based on anatomy, goals, and surgical considerations.

If you’re considering hip replacement, the most valuable conversation you can have is not just about scar placement—but about approach, planning, recovery, and long-term outcomes tailored specifically to you.

About the Author

Jennifer Wood, MD, FAAOS

Orthopedic surgeon specializing in hip and knee replacement

Recovery Simplified | Expert Joint Care