Bikinis, Tissue Protectors, and the Standard Longitudinal Incision: Comparable Wound Complications and Safety in Direct Anterior Approach Total Hip Arthroplasty

Background: Wound complications in direct anterior approach (DAA) total hip arthroplasty (THA) may differ by incision type.Bikini incisions may improve cosmesis and healing, minimizing panniculus effects while single-use soft tissue protectors may prevent damage from surgical instruments.This study compared wound complication rates in DAA THA with longitudinal incisions with and without a tissue protector, and bikini incisions.Methods: We retrospectively reviewed 925 primary DAA THAs performed via standard longitudinal incision (n = 444, 48.0%), bikini incision (n = 375, 40.5%), and longitudinal incision with a tissue protector (n = 106, 11.5%).Wound data included complication type, depth, and treatment, including return to the operating room (RTOR).Analyses included pairwise Fisher exact testing and multivariable regression, controlling for age, sex, body mass index, smoking, surgical indication, American Society of Anesthesiologists, operative time, and performing surgeon.Results: There were 37 (4.0%) wound complications-34 (3.7%) superficial wound issues (eg, dehiscence without deep infection) and 3 (0.3%) deep infections.Seven (0.8%) patients required RTOR, with no significant difference between cohorts.Compared to the standard longitudinal incision (6.5%), both the bikini incision (2.4%) and the tissue protector (0.0%) cohorts had fewer overall wound complications.When controlling for the performing surgeon, the bikini incision performed similarly to the standard longitudinal approach (adjusted Odds Ratio: 0.49; P = .23).Conclusions: DAA THA demonstrates an excellent safety profile, with a low overall incidence of wound complications.While initial reductions in superficial complications with bikini incisions and tissue protectors were influenced by surgeon-specific factors, all techniques proved to be highly safe and effective, with low RTOR rates.