{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:18:26Z","timestamp":1788344306998,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Standard protocols for the direct anterior approach (DAA) typically employ a longitudinal incision, which violates Langer's lines and may compromise scar esthetics. The oblique \u201cbikini\u201d incision aims to improve cosmesis by following natural skin tension lines, but it raises anatomical concerns regarding iatrogenic lateral femoral cutaneous nerve (LFCN) injury. This study aimed to systematically evaluate the safety, functional, and esthetic outcomes of the bikini incision versus the traditional longitudinal incision in DAA total hip arthroplasty (THA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adhering to the PRISMA 2020 guidelines, we searched major databases for comparative studies (both randomized controlled trials (RCTs) and observational cohorts) of bikini versus longitudinal incisions in DAA\u2010THA. Primary outcomes were scar cosmesis and LFCN injury incidence. Secondary outcomes included operative time and wound complications. Data were pooled using a random\u2010effects model, and subgroup analyses were performed to explore heterogeneity based on study design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eight studies comprising 2017 hips were included. The bikini incision demonstrated significantly superior scar cosmesis (SMD\u2009=\u2009\u22120.62; 95% CI [\u22121.00, \u22120.24];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) without increasing operative time (MD\u2009=\u2009\u22120.52\u2009min; 95% CI [\u22122.62, 1.58];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.63). The pooled analysis showed no significant difference in overall LFCN injury risk (OR\u2009=\u20091.19; 95% CI [0.60, 2.36];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.61); however, subgroup analysis of high\u2010quality RCTs indicated a higher risk in the bikini group (OR\u2009=\u20092.15; 95% CI [1.26, 3.68];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). Additionally, the bikini group exhibited a potential trend toward reduced wound complications, though this did not reach statistical significance (OR\u2009=\u20090.42; 95% CI [0.15, 1.15];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.09).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The bikini incision offers superior scar esthetics without prolonging operative time and demonstrates a potential trend toward minimizing wound complications. However, surgeons must remain vigilant regarding LFCN anatomy, as rigorous RCTs suggest a higher anatomical risk of nerve injury. This approach is recommended primarily for experienced surgeons who have surpassed the standard DAA learning curve.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.72509","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T03:58:20Z","timestamp":1778471900000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oblique Bikini Incision Versus Longitudinal Incision for Direct Anterior Approach Total Hip Arthroplasty: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"9","author":[{"given":"Yi","family":"Leng","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery The First Hospital of Jilin University Jilin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianzeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery The First Hospital of Jilin University Jilin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery The First Hospital of Jilin University Jilin China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,10]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-024-06238-w"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.70127"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00132-021-04078-9"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2025.03.050"},{"key":"e_1_2_13_6_1","article-title":"The Direct Anterior Approach in Total Hip Arthroplasty May Be Associated With Lower Short\u2010Term Mortality Compared to Various Other Approaches: A Dutch Arthroplasty Register Study Comprising 379,108 Procedures","author":"Vossen R. J. M.","year":"2025","journal-title":"Hip International"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-025-08683-z"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.artd.2024.101465"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-013-2806-0"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjtee.2023.02.001"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004219"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10195-024-00812-z"},{"issue":"4","key":"e_1_2_13_13_1","article-title":"Bikini Incision Modification of the Direct Anterior Approach","volume":"14","author":"Leunig M.","year":"2023","journal-title":"JBJS Essential Surgical Techniques"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40634-020-00318-7"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.artd.2022.06.010"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"e_1_2_13_18_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.5","author":"Higgins J.","year":"2024"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2021.05.012"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.07.047"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.2147\/ORR.S524339"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.03.060"},{"issue":"7","key":"e_1_2_13_25_1","first-page":"853","article-title":"Skin Crease \u2018Bikini\u2019 Incision for the Direct Anterior Approach in Total Hip Arthroplasty: A Two\u2010 to Four\u2010Year Comparative Study in 964 Patients","volume":"100","author":"Leunig M.","year":"2018","journal-title":"Bone & Joint Journal"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12031072"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/2210491719890883"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12795"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.18.00331"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2015.06.016"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/638936"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.2340\/17453674.2022.4802"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.20943"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.21043"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00276-008-0433-3"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-023-04525-7"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2024.05.078"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"}],"container-title":["Health Science Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.72509","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hsr2.72509","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.72509","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T09:55:55Z","timestamp":1788342955000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hsr2.72509"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":37,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/hsr2.72509"],"URL":"https:\/\/doi.org\/10.1002\/hsr2.72509","archive":["Portico"],"relation":{},"ISSN":["2398-8835","2398-8835"],"issn-type":[{"value":"2398-8835","type":"print"},{"value":"2398-8835","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2025-12-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72509"}}