Comparative Analysis Of Postoperative Outcomes Of Bikini Incision And Conventional Direct Incision Anterior Approach In Total Hip Arthroplasty

Aim:Comparison of the efficacy of initial total hip arthroplasty with Bikini incision anterior approach and conventional incision direct anterior approach.Method:Forty-eight patients undergoing hip replacement who were admitted to September 2017 to September 2018 and met the selection criteria were included in the study.According to the different surgical incisions,the two groups were divided into two groups: 28 patients underwent traditional direct anterior approach THA(group A),and20 patients underwent Bikini incision anterior approach THA(group B).From September 2017 to September 2018,48 patients who needed hip replacement underwent total hip arthroplasty in the Department of Joint Surgery of Second Affiliated Hospital of Dalian Medical University.They were randomly divided into two groups,THA through traditional direct anterior approach and Bikini incision.Preoperative data such as preoperative age,gender,BMI,and Visual Analogue Score(VAS)scores were collected for all patients in each group.Evaluation of postoperative hip pain improvement by visual analogue score(VAS)score.The operation time,intraoperative blood loss,hemoglobin difference before and after operation,number of blood transfusion cases after operation and length of hospitalization were recorded in detail.The pelvic plain film and lateral femoral film of affected side were taken routinely after operation for imaging evaluation.The Harris hip function score was used to evaluate the postoperative functional recovery of the affected limb,and the postoperative complications were recorded in detail.Patients with paralysis received regular visits at 1 month,2 months,and 5 months after surgery,and follow-up was performed by the same examiner.Data were analyzed using SPSS 23.0 software.The measurement data were expressed as mean ± standard deviation(SD).The data werecompared between the two groups using t test and chi-square test.Result:There were 20 patients in the Bikini group,including 4 males and 16 females,5bilateral and 15 unilateral.There were 28 patients with traditional incision and anterior approach.There were 9 males,19 females and 7 bilateral patients.21 cases on one side.No infection was found in the incision in both groups.Both groups were followed up in the first month,second month,and fifth month after surgery.There were no significant differences in age,BMI,preoperative VAS score,and preoperative Harris score between the two groups(p>0.05).There were no significant differences in hemoglobin difference,intraoperative blood loss,blood transfusion rate and hospitalization time between the two groups(P>0.05).In the case of postoperative blood transfusion,4 patients in the Bikini group received blood transfusion,and the percentage of patients who received blood transfusion was 20%.In the traditional incision,the anterior approach group had2 patients transfused,and the percentage of patients transfused was 7.1%,in the blood transfusion rate,the two groups were not statistically significant(P>0.05).In terms of imaging evaluation,the difference in length of lower limbs was not statistically significant(P>0.05).There was no significant difference in VAS scores between the two groups at 1 month,2 months and 5 months after operation(P>0.05),but it was significantly improved compared with preoperative.In terms of functional rehabilitation,there was no statistically significant Harris score in the first,second and fifth months after surgery(P>0.05).In the postoperative femoral cutaneous nerve injury rate,6 cases of lateral femoral cutaneous nerve injury occurred in the traditional incision direct anterior approach group,the complication rate was 21.4%,and 8 cases of lateral femoral cutaneous nerve injury occurred in the Bikini group.The complication rate was 40%.There was no significant difference in the rate of lateral femoral cutaneous nerve injury between the two groups(P>0.05).Conclusion: The minimally invasive THA of these two different surgical incisions can avoid muscle damage and achieve good short-term results.There was no significant difference in the rate of lateral femoral cutaneous nerve injury between the two groups(P>0.05).Compared with the traditional direct anterior approach,the Bikini incisiondirectly changes the traditional longitudinal incision and is replaced by a transverse incision along the groin skin.The incision can be covered by the patient's underwear or even a bikini.The incision has a certain cosmetic effect.