Are you considering total hip replacement?

The AMIS (Anterior Minimally Invasive Surgery) Bikini follows an intermuscular and internervous pathway, but utilizes a skin incision performed within the skin fold of the “bikini line”, or frontal groin crease.

Current approaches and AMIS
It is important to know that a surgeon can access the hip joint by different paths called surgical approaches and that there are several misleading concepts out there about what some consider “minimally invasive”. Some approaches advertised as minimally invasive (posterior, lateral or double incision approach),  only reduced skin incision techniques and are associated with the same muscle and nerve injury as “conventional” approaches.

Why an AMIS Bikini Total Hip Replacement?
The AMIS Bikini is a true minimally invasive surgical technique. In fact, the anterior approach is a technique which follows the natural direction of your muscles and nerve planes to reduce the risk of injury to muscles, tendons, vessels and nerves.[5]

The AMIS Bikini combines all the benefits of the AMIS technique with the additional advantages of the groin crease incision:

  • Better aesthetic appearance.[1,2,3,4]
  • Enhanced wound healing environment and lower rate of wound complications
    (also indicated for patient with high BMI).[1,2,3,4]

The AMIS approach is a true intermuscular and internervous minimally invasive surgical technique.


AMIS can potentially provide you with the following benefits:

  • Decreased post-operative pain[6] – The AMIS approach can reduce the post-operative pain because muscles are not cut.
  • Significantly shortened rehabilitation[7] – Rehabilitation can usually start the day of the operation or the day after, subject to your doctor’s approval, based on your post-operative condition.
  • Shorter hospitalization[8] – The AMIS technique usually significantly reduces the duration of hospital stay.
  • Small skin scar[9] –  With AMIS, the skin incision is often shorter than with “conventional” surgery.
  • Faster return to daily activities[10] – The AMIS technique allows you to return to daily activities in a shorter time frame.
  • Decrease in blood loss[8] – The preservation of muscles and vessels potentially reduces blood loss.
  • Reduced risk of dislocation (separation of the hip ball and socket)[6,8,10] – The risk of dislocation is reduced because the anterior approach is performed from the front of your body and dislocation is mainly related to posterior hip structure damage.
  • Prevention of limping[11] – Minimizing muscle and nerve damage reduces the chance of limping. (Please note that some people who were limping before surgery do form a limping habit that can be hard to break).

You can learn more about Dr. Callahan at, or make an appointment by calling his Beachwood office at 800-HIP-7485.

Bibliographic references:
[1] Menzies-Wilson, Richard & Mahalingham, Karuppiah & I, Tamimi & Field, Richard. (2019) “Retrospective cohort study comparing the functional outcomes of
direct anterior approach hip arthroplasty. Oblique “bikini” vs longitudinal skin incision.” [2] Menzies-Wilson, Richard & Mahalingham, Karuppiah & I, Tamimi & Field,
Richard (2019).”Functional Outcomes of direct anterior approach hip arthroplasty: Oblique ‘bikini’ versus longitudinal skin incision.” 10.1177/2210491719890883.
[3] Leunig, Hutmacher, Ricchiardi, Impellizzeri, Rüdiger, Naal (2018). “Skin crease ‘bikini’ incision for the direct anterior approach in total hip arthroplasty: a two- to
four-year comparative study in 964 patients.” Bone Joint J. [4] Manrique, MD, Paskey, BS a, Tarabichi, MD, Restrepo, MD, Foltz, PhD Hozack, MD. (2019) “Total
Hip Arthroplasty Through the Direct Anterior Approach Using a Bikini Incision Can Be Safely Performed in Obese Patients.” J Arthroplasty [5] Single-Incision
Direct Anterior Approach for Total Hip Arthroplasty Using a Standard Operating Table; TP Lowell; The Journal of Arthroplasty Vol. 23 No. 7 Suppl. 1 2008
[6] Vasina PG, Rossi R, Giudice GM, Palumbi P. Hip arthroposthesis through the anterior minimally invasive approach. Sphera 2010;6(12) – Speciale Ortopedia.
[7] Dora C. Minimalinvasive Zugänge an der Hüfte. Orthopäedie Mitteilungen 6/07, 574-576. [8] Jayankura M, Roty M, Potaznik A, Rooze M, Cermak K, Remy P,
Gillard B, Biltiau N, Schuind F. Isokinetic and isometric muscle strength recovery after total hip arthroplasty implanted by direct anterior approach. Podium
presentation at the 10th Annual Congress of the EFORT, Vienna, Austria, June 3-6, 2009. [9] F Rachbauer, Minimally Invasive total hip arthroplasty: anterior
approach, Orthopäde, 2006 Jul, 35(7):723-4, 726-9 [10] Laude F. Total hip arthroplasty through an anterior Hueter minimally invasive approach. Interact Surg
(2006) 1: 5-11. [11] Bremer AK, Kalberer F, Pfirrmann CWA, Dora C. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement:
Comparison between the direct anterior approach and the transgluteal approaches approaches. J Bone Joint Surg (Br) 2011–July; 93-B:886-9.