Transverse incisions improve scar outcomes in anterolateral supine approach total hip arthroplasty - a patient observer scar assessment scale-based study

Q: What surgical incision types were compared in this study?

The study compared transverse and longitudinal skin incisions in anterolateral supine (ALS) total hip arthroplasty (THA). Longitudinal incisions were used until December 2022, then transverse incisions aligned with relaxed skin tension lines were used thereafter.

Q: How was scar quality measured?

Scar quality was evaluated using POSAS 3.0 (Patient Observer Scar Assessment Scale). Assessment covered satisfaction, appearance, and sensory domains.

Q: What were the main findings regarding patient-reported outcomes?

Regression analysis showed transverse incisions significantly improved satisfaction and appearance compared with longitudinal incisions. No significant differences were found in overall POSAS scores, and sensory scores were influenced by follow-up duration.

Sep 29, 2026

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Study assessed whether transverse skin incisions improve cosmetic and sensory results after anterolateral supine (ALS) total hip arthroplasty (THA). A retrospective cohort of 132 primary ALS THA hips treated by a single surgeon (2019–2024) compared longitudinal incisions used until Dec 2022 with transverse incisions aligned to relaxed skin tension lines thereafter. Scar quality was evaluated with POSAS 3.0 across satisfaction, appearance, and sensory domains. Transverse incision improved satisfaction and appearance, with no significant POSAS score differences overall and sensory effects linked to follow-up duration.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

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Kuramitsu et al. Arthroplasty (2026) 8:2 [https://doi.org/10.1186/s42836-025-00354-7](https://doi.org/10.1186/s42836-025-00354-7) Arthroplasty RESEARCH Open Access Transverse incisions improve scar outcomes in anterolateral supine approach total hip arthroplasty: a patient observer scar assessment scale-based study Yujiro Kuramitsu 1, Junya Itou 1*, Yutaro Munakata1 and Ken Okazaki1 Abstract Background This study compared transverse and longitudinal skin incisions in anterolateral supine (ALS) total hip arthroplasty (THA), focusing on cosmetic and sensory outcomes using the Patient Observer Scar Assessment Scale (POSAS) . Methods A retrospective analysis was conducted on 132 hips that underwent primary ALS THA performed by a single surgeon between 2019 and 2024. Longitudinal incisions were used until December 2022, and transverse incisions aligned with relaxed skin tension lines were used thereafter. POSAS 3.0 was used to evaluate scar quality across satisfaction, appearance, and sensory domains. Results Baseline characteristics were similar between groups, except for follow-up duration and incision length. No significant differences were found in POSAS scores. However, regression analysis revealed that transverse incision significantly improved satisfaction (P = 0 . 04) and appearance (P < 0. 05) . Sensory scores were significantly affected by follow-up duration (P < 0. 001) . Conclusion Transverse incisions in ALS THA may enhance cosmetic satisfaction without compromising sensory outcomes. These findings support the potential role of personalized incision planning for improving patient-reported outcomes following THA. Keywords Total hip arthroplasty, Patient observer scar assessment scale, Transverse incision, Longitudinal incision, Anterolateral supine approach Introduction Total hip arthroplasty (THA) is excellent for relieving pain and is considered one of the most successful surgeries of the twentieth century [1]. However, in recent years, many patients hope to achieve high levels of postoperative function, and greater emphasis is being placed on *Correspondence: Junya Itou [jun718@gmail.com](jun718@gmail.com) 1 Department of Orthopaedic Surgery, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku, Tokyo 162-8666, Japan patient satisfaction [2]. Many studies investigated the factors that determine satisfaction after THA [3], and surgical incision is considered an important factor. In the direct anterior approach (DAA), one of the anterior approaches to THA, a transverse skin incision called the bikini incision has been attracting attention [4–6]. Classical longitudinal incisions do not follow the relaxed skin tension line (RSTL), which may impair wound healing and result in poor cosmetic results. The importance of the skin incision is thought to be similar in the anterolateral supine approach (ALS) [7–9]. Compared with DAA, ALS has attracted attention because of its lower © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/.)[.](http://creativecommons.org/licenses/by/4.0/.) Kuramitsu etal. Arthroplasty (2026) 8:2 Page 2 of 7

FAQs

What surgical incision types were compared in this study?

The study compared transverse and longitudinal skin incisions in anterolateral supine (ALS) total hip arthroplasty (THA). Longitudinal incisions were used until December 2022, then transverse incisions aligned with relaxed skin tension lines were used thereafter.

How was scar quality measured?

Scar quality was evaluated using POSAS 3.0 (Patient Observer Scar Assessment Scale). Assessment covered satisfaction, appearance, and sensory domains.

What were the main findings regarding patient-reported outcomes?

Regression analysis showed transverse incisions significantly improved satisfaction and appearance compared with longitudinal incisions. No significant differences were found in overall POSAS scores, and sensory scores were influenced by follow-up duration.

Sep 29, 2026

Upload by Dipper