Dr Rajesh Malhotra, professor and head of orthopaedics at AIIMS, told TOI that unlike the conventional approach for conducting hip replacement, which leaves behind a noticeable scar, the modified technique is done in a manner that few can tell surgery has been done even if the patient wears a bikini.
“Very few centres in the world do this surgery. It’s challenging and takes longer than usual, but we decided to adopt it to help young women who are hesitant to undergo the procedure for fear of the residual scar,” added Malhotra.
There are three main approaches for a hip replacement surgery. In the posterior approach, the surgeon makes an incision on the back of the hip joint and cuts the gluteus maximus muscle to remove the damaged joint and replaces it with artificial parts. In the anterolateral approach, the incision is made on the outer side of the thigh. In the anterior approach, a vertical incision is made on the front of the hip to replace the joints without cutting or splitting the muscles.
The bikini surgery is a modified version of the anterior approach where the surgeons make a horizontal incision along the bikini line to ensure minimal scar. Further, special cosmetic stitches are used to minimise the noticeability of the scar.
Malhotra said the operation through the bikini incision, which is only 6-8cm in width, was more challenging than the other approaches because the field of vision and operation was less. “It needs a lot of experience and the right selection of patients to succeed,” he added.
AIIMS conducted the first such surgery last year. Till date, 20 surgeries have been performed. Nine patients suffered from avascular necrosis of the head of the femur, six patients had a history of damage to the hip joints due to rheumatoid arthritis, two others suffered from arthritis caused due to lupus and bone damage due to tuberculosis, and one patient developed avascular necrosis of the hip and extreme pain post-Covid. Most of the patients were young women.
A mini-review on the psychology of scars published in the journal Psychiatria Danubina in 2018 stated that scarring may be skin deep, but psychological impact went deeper. “The evidence is decisive; the presence of scars can result in clear markers of mental disturbance in patients with associated symptoms of depression, anger, anxiety and post-traumatic stress. A scar creates physical, emotional and psychological marks. Identity is called into question and individuals must integrate the scar with their sense of self to achieve psychological acceptance. This process causes a change of behaviour and reduced functioning, socially and psychologically, driven by the fear of being singled out. Hiding the scars relieves maladaptive behaviour and often leads to a return to normal functioning.”