Comparison of the Short-Term Patient Reported Outcome Measurement of the Skin Crease “Bikini” Incision Anterolateral Supine Approach versus the Direct Lateral Approach in Total Hip Arthroplasty: 1:1 Matching Analysis

Purpose: This study compared the clinical utility and safety of the muscle-sparing anterolateral supine (ALS) approach using a skin-crease bikini incision with the conventional direct lateral (DL) approach in terms of the short-term patient reported outcome measurement (PROM) and the postoperative complication rates.Materials and Methods: Between March 2023 and February 2024, patients who underwent primary total hip arthroplasty at a single institution were reviewed retrospectively.Ninety patients were identified in the ALS group, and 264 were identified in the DL group.After 1:1 matching for age, sex, and body mass index, 87 patients in each group were analyzed.The primary outcomes were the PROM, including the modified Harris Hip Score (mHHS), Oxford Hip Score (OHS), and Hip Disability and Osteoarthritis Outcome Score (HOOS), evaluated preoperatively and at six weeks, three months, six months, and one year postoperatively.The secondary outcomes included postoperative complications such as transient sensory changes, permanent nerve injury, dislocation, superficial and deep infections, intraoperative fracture, and iliopsoas tendinitis.Results: All three PROM (mHHS, OHS, and HOOS) showed statistically and clinically superior results in the ALS group compared to the DL group within the first six months postoperatively.No significant differences in the incidence of any recorded complications were observed between the two groups.Conclusion: At three and six months postoperatively, the ALS approach with a bikini incision showed superior PROM compared to the DL, suggesting better early functional recovery and patient satisfaction.Although the PROM differences diminished at one year, the early postoperative advantage highlights the clinical benefits of the muscle-sparing ALS approach.