Bikini Hip Replacement

Dr. Nizam performs almost all Hip replacements through the Direct Bikini muscle sparing approach (Bikini Line Cut). This is also called Bikini cut hip replacement or Bikini Total Hip Replacement with Hidden cosmetically pleasing scar in the groin.

What is Bikini Hip Replacement?

True minimally invasive (Mini Incision) muscle sparing (inter-muscular and inter-nervous plane) procedure.

It preserves Muscles and Tendons

Hidden Scar in groin.

Bikini Hip surgery has been carried out in Europe for several decades (Hueter Approach) with excellent outcomes

Smaller cut than the traditional posterior/lateral or anterolateral approaches.

Advantages Include:

  • Less post-operative pain (improved further with Enhanced Recovery Program)
  • Less Pain as Muscles are Not “cut”
  • Less Blood Loss
  • Less muscle weakness
  • Early Mobilization (as early as 4 hours after surgery)
  • Rapid recovery
  • Hidden Scar in the Groin
  • Less risk of dislocations
  • Early discharge home
  • Drive as early as 9-12 days after surgery

The Bikini Line Incision? (Where is the Cut?)

Dr. Nizam does this approach through a Bikini Line Incision (Groin Crease Incision) on the front of the hip joint, rather than a long (straight line) scar on the side or back– see below.

The scar remains hidden in the groin crease

Who is Suitable ?

The main indications for Bikini hip replacement:

Significant arthritis/inflammatory process (rheumatoid) affecting the hip joint resulting in increased pain, reduced mobility and function.

It can also be performed for fractured hips in some cases.

Exceptions: Very Obese or Very Muscular patients, which makes the surgery technically difficult even in the most experienced hands. Bikini Hip surgery can be difficult to perform in cases of complex revision hip surgery where a traditional posterior hip replacement is better.

Is Traction Table Used?

Dr. Nizam Does NOT use a Traction Table to distract the hip. But uses a Standard Operating Table with special instrumentation.

There are Advantages and Disadvantages using Traction Tables which can be discussed at consultation.

Is Bikini Hip Replacement the Best?

No one can claim that Bikini hip replacement is the best. There are advantages and disadvantages between different approaches and Dr. Nizam was trained in all the approaches.

Bikini Anterior Hip replacements certainly has advantages over traditional hip surgery with less pain and faster recovery.

 The Facts: Bikini Vs Standard Posterior Hip Replacement:
  Bikini Approach Posterior Approach
 Patient position  on your back  on your side
 Traction Table to distract hip
 Usually Used (Dr. Nizam does not use a traction  table)  Not Used
 Incision Site  Groin  On the side/back of hip
 Incision length  6-9cm (variable)  9-15cm (variable)
 Minimally Invasive Surgery  Yes  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 no risk, 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  Yes (depending on experience & technique)Minimal (with experience)  Yes (depending on experience & technique) 

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

Does it give good Access/Exposure?

Yes, Despite the size of the incision, there is good exposure of the acetabulum (Cup) and the Proximal Femur, enabling good access to the hip joint.

Minimally Invasive, Muscle Sparing approach to Hip Joint Replacement through a bikini line incision.

The Neck is resected after hip joint is exposed1. The Neck is resected after hip joint is exposed
Reamers2. Femur (thigh Bone) and Acetabulum (Cup) is prepared (Reaming)
post-operative condition3. Prosthesis inserted
xray appearance4. Xray Appearance


Who is suitable for this type of surgery?

Surgery is usually recommended by the surgery after careful diagnosis of a hip problem. Majority or patients could be performed through the Bikini approach. Details can be discussed by appointment with Dr. Nizam.


Cup or Acetabulum: This involves replacing the worn socket “acetabulum” with an acetabular component with durable bearing surfaces (ceramic or plastic).

Stem or Femoral Component: The ball (of the ball and socket), 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, bone density.


Metal-on-Metal Implants?

Dr. Nizam does NOT use metal-on-metal Total hip replacements. We do however still use the Birmingham hip resurfacing which is one of the most successful prosthesis.



This service will be provided by our experienced anaesthetic Group.

You can visit their website by clicking here

Further information:

A further detailed information sheets/booklet will be given by Dr. Nizam to his patients undergoing specific surgical procedures outlining pre-operative preparation/instructions, details of the surgery, post operative outcome, rehab where required, surgical risks/ complications and follow-up.

Our Rapid Recovery Program with Pain Management in Joint replacements:

The first part involves injecting local anaesthetic and other agents into the operative site at the time of surgery, in essence to “numb” that part so that after surgery patients wont feel any significant pain. The details of this will be discussed in at consultation.

This will enable patients to walk within 3 to 4 hours after joint replacement with less pain, discomfort, less nausea/vomiting, less muscle weakness and rapid recovery.

In the majority of cases, patients will be discharged home the following day after Joint Replacement with crutches. Yes, this is possible.

Dr. Nizam worked with the team (Professor L. Kohan and Dr. D. Kerr) for over 6 years in Sydney that pioneered this pain management and early mobilization regime over 14 years ago with very good outcomes.

Walking and Activities of Daily Living:

The patients are usually walking by 3 to 4 hours using our pain management program.

Patients are encouraged to wear their own clothing the night of surgery and “street ready”.

Wound drains/Catheter tubings: Dr. Nizam does not routinely use drains and catheters as this may increase risk of transfusion and infection, but more importantly slows down mobilization.

What to expect after Joint Replacement Surgery:

Each patient is treated as an individual with age, physiological status, health and patient attitudes considered.

The first 4-7 days:

  • Swelling: Is common after any lower limb surgery. This is can vary extent and distribution. This usually decreases with time. We encourage walking and muscle activity as this will reduce 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.


Depending on the complexity of surgery, patients can drive as early as from 1-4 weeks after joint replacement surgery (individual results may vary).


Patients are able to sleep on the side or back. The only restriction being not to extend the leg with the toes pointing outwards (hip extension with external rotation).


This can be commenced almost as soon as comfort and confidence allows. Frequency may vary from little to as regular as taking panadol!.

Scar Management:

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 cream/lotion can help. Silicon gel sheets(on 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, stiffness, nerve/vessel damage. Other risks of surgery will be discussed by Dr. Nizam before any surgery is to be undertaken.