Brett Shore, MD, an orthopedic surgeon at DISC Sports and Spine Center in Marina del Rey, Calif., has spent his time as a hip specialist perfecting a minimally invasive incision approach, the “bikini incision,” that he learned during his time in training.
The incision has several major benefits for patients, including offering a faster recovery and cosmetic pros. Dr. Shore spoke with Becker’s about the bikini incision, and what else is revolutionizing hip replacements right now.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Can you talk about the benefits of your minimally invasive approach to anterior total hip replacements?
Dr. Brett Shore: The main difference, or the main thing I’m doing, is basically the skin incision. The actual surgical approach is basically the same for anterior total hip, but the difference is that while I was in Switzerland, I worked with a surgeon who did all of his total hips through bikini incision instead of longitudinal. By spending a lot of time with him, he did all of them through that incision and so by spending a lot of time with him, he showed me how to use it properly and what the benefits were. Benefits from his perspective, because he wasn’t doing this for a marketing reason or cosmetic reason, from his perspective, the benefits were more predictability and better healing. The tension lines of the skin run in an oblique orientation, and the bikini incision follows the lines of the skin. When you make an incision that follows those lines, it heals more narrowly, it doesn’t scar, you don’t get as much scarring. The second benefit is that the upper portion, the most proximal portion of the standard incision, goes across a flection crease which puts the incision under stress. This incision is slightly lower, further down the leg, and it doesn’t see the inflection crease. As a secondary benefit, it looks pretty. It’s a more cosmetic incision. There are still times when it’s appropriate to do longitudinal, but for the majority, and 98% of hip replacements, I use bikini style.
Q: Can you share a few first-hand stories of how this has benefited your patients?
BS: Any individual patient doesn’t really know what their healing would’ve been like with another incision. I know, because I have seen it, but they don’t have that perspective. But they do appreciate the cosmetics and that the incision can be hidden literally under a bikini. To be honest, I have had a few patients say they came to me because they googled bikini incisions, because they heard about it and that’s how they found me.
Q: What other trends in orthopedics are you keeping an eye on?
BS: One of the trends in orthopedics, with hip replacements in particular, is because we have an understanding that hip replacements are lasting longer and longer and patient satisfaction with hip replacements is very high, one of the highest there is for any operation we do, I think there’s been a move, particularly among hip replacement surgeons, to be willing to do them on younger patients and to do them, not earlier in the disease process, but with less inclination to do everything possible to ignore surgery when it’s obvious surgery is inevitable. We now have the understanding that the younger and healthier a patient is, the better they can recover. The benefits of doing these surgeries before patients spend a lot of time suffering is you get to help them before they lose muscle mass. It makes recovery easier and overall benefits their lifestyle. With hip replacements, in particular, there is very little in terms of postoperative restrictions. I don’t want my patients being long-distance running, and I don’t want them deadlifting 400 or 500 pounds, but almost everything else people want to do, including exercise, surfing, all that stuff, is perfectly safe after hip replacements because we know how well they work.
Q: Are you facing any challenges when it comes to operating on younger patients?
BS: I do, occasionally. I think the biggest challenge is just, for some patients, some are completely happy to just get the hip replaced and be done with it, but with younger patients since I also do hip preservation, a lot of times younger patients will come to me because they want arthroscopic hip surgery to preserve the hip. When I actually see the imaging, I know it won’t work. Given that they came to me for hip preservation and they leave with me telling them what they need is a hip replacement, there is some apprehension. For the most part, because I know the same patients would get the same answer from any hip surgeon, the pusback isn’t too bad. Understandably, to someone in their 40s if you tell them you are going to replace their hip, their first response is to say, “But I am not 70.”
