The Total Hip Replacement (THR) rate in the United States is rapidly rising. In 2030, approximately 850,000 surgical procedures are expected. The Anterior Hip Replacement is a relatively new approach to a THR. The procedure has recently gained popularity due to its minimally invasive approach and small incision, promising faster recovery and less pain. In this blog post, we will dive into the world of anterior hip replacement scars, exploring what they are, how they heal, and what you can do to minimize their appearance.
Understanding the Anterior Hip Replacement
Total Hip Replacement surgery or Total Hip Arthroplasty (THR) is a surgical procedure to replace the affected femoral head and the acetabulum. The main indication for THR is due to hip arthritis. There are three ways to access the hip: anterior (front), lateral approach (side), and posterior (back). The posterior approach is the traditional hip replacement surgery, the most common method with up to a 6-inch incision in the back of the hip.
In a direct anterior approach, the surgeon makes the incision on the front of the hip, allowing access to the ball and socket joint without cutting any soft tissues. Instead, the surgeon can separate the muscles along their natural tissue planes to replace the femoral head and the acetabulum with an artificial one: metal, plastic, or ceramic. Since no hip muscles were cut, there are no hip precautions. This surgical approach has a smaller incision, allowing for “quicker recovery and less pain.” The total recovery time for an anterior hip surgery is up to 12 weeks.
9 Care Tips for Your Anterior Hip Replacement Scar
- Follow Your Orthopedic Surgeon’s Instructions: Following your surgeon’s post-operative instructions is the first and most crucial step in caring for your anterior hip replacement scar. Your surgeon is the expert who knows the specifics of your case, and their guidance is tailored to your unique needs. Adhering to their advice is crucial for a successful recovery. A surgeon’s instructions may have these tips:
- Change your position every hour to prevent blood clots. Laying in one position for many hours can cause your blood to pool and settle.
- Elevate the affected leg.
- Ice with a towel for 20 to 30 min with 20-minute breaks between icing
- Remain covering the incision with a surgical bandage to prevent infection.
- Take prescribed pain medication as needed.
- Keep the Incision Clean and Dry: Proper hygiene is essential for preventing infections and supporting the healing process. Keep the incision area clean and dry during the initial healing stage (typically the first two weeks). Gently cleanse the area as instructed by your surgeon, and avoid soaking the incision site in water, such as baths or hot tubs.
- Scar Massage: As your incision heals, you may experience some scar tissue formation. Gentle scar massage can help soften and flatten the scar. Ask your surgeon or physical therapist for guidance on proper massage techniques to ensure you don’t damage the incision site.
- Products to Reduce the Appearance of Scars: Silicone Gel Sheets are the best options for managing surgical scars. These products create a barrier that hydrates and protects the scar, potentially improving its appearance. Consult your surgeon before using any of these products, as they can recommend those that are safe and appropriate for your situation.
- According to Medical News Today, the best scar cream for surgical scars is ScarAway Clear Silicone Scar Sheets.
- The 2023 best scar creams for surgical sites by Healthline was the Cica-Care Gel Sheet.
- Mederma Advanced Scar Gel is a loved product by customers with sensitive skin. Please note this product is only recommended once the scar is completely sealed.
- Sun Protection: Prolonged exposure to the sun’s harmful UV rays can make scars more noticeable. Protect your scar from direct sunlight by using sunscreen or covering it with clothing, especially during the first year when the scar is most vulnerable. Using mineral sunscreen for surgical scars is recommended for the best results. The Neutrogena Sheer Zinc Face is an affordable and excellent choice.
- Stay Hydrated and Eat a Balanced Diet: Your body’s natural healing processes benefit from proper nutrition and hydration. Ensure you drink enough water and maintain a well-balanced diet rich in vitamins and nutrients to support optimal healing. A water bottle with a time marker can help you keep track of your water intake.
- Manage Itchiness and Discomfort: Itching around the scar is expected during the healing process. Avoid scratching or picking at the incision, which can lead to complications. Over-the-counter antihistamines may help relieve itchiness, but consult your surgeon before taking new medications.
- Monitor for Signs of Infection: Watch your scar for any signs of infection, such as increased redness, swelling, or discharge. If you notice these symptoms, contact your surgeon immediately, as timely intervention is essential.
- Patience and Time: After a total hip replacement surgery, the hospital stay is about 1-2 days. The full recovery of the surgery takes up to 12 weeks. Please reference the Anterior Hip Replacement Recovery Guide By Week for in-depth details. As for the scar, it’s a gradual process and may take several months to a year for the skin to mature and become less visible.
Healing Process of Anterior Hip Replacement Scar
The anterior hip replacement scar begins with the surgical incision. The surgeon typically makes an incision along the front of the hip, about 3 to 4 inches long.
The anterior hip replacement scar is naturally healing like any other surgical incision. Understanding this process can help you manage expectations and take steps to ensure proper healing. The healing process can be broken down into the 4 phases of wound healing (reference to O’Sullivan, Physical Rehabilitation Book):
- Inflammation Phase (0-10 Days): Immediately after the surgery, the incision is closed with sutures or staples. During this period, the scar is very fresh and vulnerable. Patients are advised to keep the area clean and dry to prevent infection. Following your surgeon’s post-operative care instructions is crucial to facilitate proper healing.
- Your body will start its natural immune response to the surgical site.
- Your body will temporarily repair the wound by coagulation factors such as platelets.
- There will be increased blood flow to the area to deliver oxygen to keep the phagocytic cells (white blood cells that eat foreign bacteria or dead cells) functioning.
- The increase in blood flow causes swelling.
- Proliferation Phase II (3-20 Days): During this phase, the scar may itch and appear thicker as collagen production increases. It’s important to avoid scratching or picking at the scar, which can lead to complications.
- New tissue begins to form to repair the incision.
- Skin integrity is restored by re-epithelialization
- Angiogenesis occurs when new blood vessels grow into the wound bed.
- Remodeling Stage (day 9 – 2 years): How fast your skin heals depends on the size of the wound, blood supply, availability of nutrients, and extrinsic environment.
- Maturation of new tissue
- The new skin has tensile strength.
- Over time, the scar tissue matures, changing from red to pink to white and from raised and rigid to flat and flexible.
Traditional Anterior Hip Replacement Scar vs Bikini Anterior Hip Replacement Scar
Traditional anterior hip replacement surgery has been performed for decades and is still highly effective for alleviating hip pain and improving mobility. However, it typically results in a more visible scar.
In the traditional approach, the surgical incision is made at the front of the hip, usually along the upper thigh. The incision length may vary but is generally 3 to 4 inches long. This placement allows the surgeon to access the hip joint to replace damaged or deteriorated parts with prosthetic components.
In recent years, a less conspicuous alternative known as the bikini hip replacement has gained popularity among patients seeking anterior hip replacement surgery. Dr. Nizam, an International Surgical Educator and Teacher of the Bikini Hip Replacement techniques, designed and published this method around 2015. He defines it as “the bikini hip replacement is minimally invasive Anterior Hip Replacement technique that is soft-tissue sparing and vessel sparing (preserving lateral circumflex blood vessels) compared to the standard incision anterior hip replacement scar.”
The Anterior Bikini Total Hip Replacement takes its name from its location at the bikini line. It typically has a smaller scar, about 2 to 3.5 inches. The bikini approach makes it easier for you to conceal the incision with clothing, making it an attractive option for those who want to minimize the aesthetic impact of surgery. Furthermore, due to a small incision and its location, it has claimed quicker recovery with less pain and early independent ambulation (walking).
The Takeaway
Anterior hip replacement surgery is a life-changing procedure that can significantly improve mobility and quality of life. While the resulting scar is an inevitable part of the process, it should not deter you from considering this effective treatment option. By understanding the scar’s healing process and following appropriate scar management techniques, you can minimize its appearance over time.
Your anterior hip replacement scar tells a story of healing and recovery, a testament to your journey toward a pain-free and more active life. Embrace it as a symbol of your strength and resilience, and remember that the scar will fade with time, leaving you with a newfound lease on life.
If you have concerns about your anterior hip replacement scar or its healing process, don’t hesitate to contact your surgeon for guidance and reassurance. Your medical team supports you throughout your recovery, ensuring you achieve the best possible outcome.
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References
1. Nizam, I. (2015). The Bikini Hip Replacement – Surgical Technique Preserving Vessels and Deep Soft Tissues in Direct Anterior Approach Hip Replacement. HSOA Journal of Orthopedic Research and Physiotherapy, 1(2). https://doi.org/https://www.ozorthopaedics.com.au/pdf/the-bikini-hip-replacement-surgical-technique.pdf
2. Singh JA, Yu S, Chen L, Cleveland JD. Rates of Total Joint Replacement in the United States: Future Projections to 2020-2040 Using the National Inpatient Sample. J Rheumatol. 2019 Sep;46(9):1134-1140. doi: 10.3899/jrheum.170990. Epub 2019 Apr 15. PMID: 30988126.
3. O’Sullivan, S. B., Cullen, K. E., & Schmitz, T. J. (2014). Physical rehabilitation. F.A. Davis Co.
4. Manske, R.C. (2016) Fundamental Orthopedic management for the physical therapist assistant. St. Louis, MO: Elsevier.
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