A hip replacement scar is a straight or slightly curved line, typically running along the outer thigh, the front of the hip, or the buttock area, depending on which surgical approach your surgeon used. Fresh scars look red or pink and slightly raised, often with visible staple or stitch marks along their edges. Over months, most settle into a pale, flat line somewhere between about 8 and 18 centimeters long. But “what it looks like” varies more than many people expect, because the approach, closure method, your skin type, and how healing goes all leave their fingerprints on the final result.
Where the Scar Ends Up Depends on the Surgical Approach
The single biggest factor shaping your scar’s appearance is the surgical approach, meaning the direction the surgeon cuts through skin and tissue to reach the hip joint. The most common approaches each leave a scar in a different spot:
- Posterior approach: The incision runs along the back or side of the hip, curving over the buttock. This has been the most widely used approach for decades, and its scar sits where clothing usually covers it.
- Lateral approach: The cut runs along the outer thigh, roughly over the greater trochanter (the bony bump you can feel on the side of your hip). The scar is visible from the side.
- Direct anterior approach (DAA): The incision is made at the front of the hip, often in or near the groin crease. Because it follows the natural skin folds in that area, the scar can be less conspicuous once healed, especially in swimwear or shorts.
Surgeons sometimes choose an approach based on their training, the patient’s anatomy, or whether a previous hip surgery left a scar they can reuse. In revision surgery, guidelines recommend reusing a healed incision when possible to avoid creating additional scarring.1PubMed Central. Surgical approaches in revision arthroplasty For a first-time replacement, the approach is usually chosen for its surgical advantages, with scar location as a secondary consideration.
How Long Is the Incision?
A standard hip replacement incision runs roughly 15 to 18 centimeters, about the length of a dollar bill or a bit more. In one randomized trial, the standard-incision group received cuts averaging 18 centimeters, while the minimally invasive group started at about 8 centimeters (though those incisions were extended to 18 centimeters at the skin level by the end of the procedure for comparison purposes).2PubMed Central. Minimally invasive versus classic procedures in total hip arthroplasty: a double-blind randomized controlled trial Another trial randomized patients into 8-centimeter and 15-centimeter incision groups.3PubMed. Minimally invasive total hip arthroplasty: a prospective randomized study
So if you are looking at a healed hip replacement scar and wondering whether it is “normal,” anything from about 8 to 20 centimeters is within the expected range. Minimally invasive techniques aim for the shorter end, while standard approaches land at the longer end. The scar itself is usually a single straight or gently curved line. You will not see branching cuts or zigzag patterns unless there were complications or a revision.
A Shorter Scar Does Not Always Mean a Better-Looking Scar
This surprises most people. The instinct is that a smaller incision should leave a neater scar, but the evidence says otherwise. A study comparing mini-incision and standard-length scars about two years after surgery found that more of the mini-incision scars were rated “poor” by blinded observers: six out of twenty mini-incision scars were judged poor, versus just one out of fourteen standard scars. The standard-incision group actually had more scars rated “good.”4Clinical Orthopaedics and Related Research. Comparison of Scars from Total Hip Replacements Done with a Standard or a Mini-incision
The reason comes down to what happens underneath the skin. When the surgeon works through a very small opening, they need to pull harder on the surrounding tissue with retractors to see and reach the joint. That extra pressure can bruise and damage the skin edges, leading to wider, more irregular healing. Two of the twenty mini-incision patients in that study had wound-healing problems, compared to none in the standard group.4Clinical Orthopaedics and Related Research. Comparison of Scars from Total Hip Replacements Done with a Standard or a Mini-incision So a scar that looks shorter is not necessarily one that looks better. The quality of healing at the wound edges matters more than the total length.
The Bikini Incision
A newer variation on the direct anterior approach uses what surgeons call the “bikini incision.” Instead of the typical vertical or oblique cut used in a standard anterior approach, the bikini incision runs more horizontally, placed parallel to the natural skin creases in the groin area. The idea is that aligning the cut with the skin’s tension lines reduces the risk of raised, thickened scarring and produces a scar that hides inside a swimsuit or underwear line.5PubMed. Direct anterior approach for total hip arthroplasty using the “bikini incision”
The concept is borrowed from plastic surgery principles: cuts that follow your skin’s natural lines of tension tend to heal flatter and narrower than cuts that cross them. Whether the bikini incision delivers meaningfully better cosmetic outcomes in large-scale studies is still being investigated, but it reflects a growing interest among orthopedic surgeons in treating the scar as part of the surgical outcome rather than an afterthought.
Staples, Stitches, and Glue
After the surgeon finishes the joint work, the skin has to be closed, and the method of closure affects what the scar looks like in the short term and sometimes the long term. The three main options are surgical staples, sutures (stitches), and skin adhesive (medical-grade glue).
Staples are the fastest to apply and are extremely common in hip replacement. They leave a characteristic pattern of small dot-marks along either side of the main scar line, sometimes called “railroad track” marks. Sutures can be placed in various patterns, and absorbable sutures buried beneath the skin surface leave no surface marks at all. Skin adhesive creates a smooth surface closure without any puncture marks.
A meta-analysis comparing staples and sutures for hip arthroplasty skin closure found no significant difference in wound evaluation scores between the two methods.6PubMed Central. Staples versus sutures for skin closure in hip arthroplasty: a meta-analysis and systematic review A randomized trial comparing skin adhesive to staples similarly found no significant difference in cosmetic appearance at three months, nor in complication rates or patient satisfaction.7PubMed. Skin closure after total hip replacement: a randomised controlled trial of skin adhesive versus surgical staples The takeaway: by a few months out, the closure method probably does not make a dramatic difference. In the first couple of weeks, staples look more alarming than glue or buried sutures, but once they are removed and healing progresses, the final scar appearance converges.
What the Scar Looks Like Over Time
If you are looking at a hip replacement scar a week after surgery, you are seeing the most dramatic version of it. The area will be red, swollen, and possibly bruised, with staple or stitch marks visible. There may be small amounts of dried blood or serous fluid (a clear yellowish liquid) around the closure. The surrounding skin might be discolored from surgical prep solution. None of this reflects the final result.
Over the following weeks and months, the scar goes through predictable stages. In the first two to three weeks, the wound edges knit together and any staples or non-absorbable sutures are removed. The scar stays pink or red during this phase because of increased blood flow to the healing area. Between one and three months, the scar is in its most active remodeling phase. It may feel firm, slightly raised, and itchy. The color is still noticeably pink or reddish. By six months to a year, most hip replacement scars have flattened and faded to a pale line that blends more closely with the surrounding skin. In people with darker skin, the scar may remain somewhat darker or lighter than the surrounding area for longer.
Full maturation of a surgical scar takes about twelve to eighteen months. Some people are left with a nearly invisible thin white line; others have a wider, more visible mark. The final appearance depends on genetics, skin type, age, and whether any complications slowed the healing process.
When Scars Heal Abnormally
Most hip replacement scars heal unremarkably. But a subset of patients develop hypertrophic scars, meaning the scar becomes thicker, firmer, and more raised than expected, sometimes with redness or itching that persists. A study examining scarring in a Chinese population found that about three-quarters of surgical scars showed some degree of hypertrophic features based on thickness, firmness, pigmentation, and blood vessel changes.8PubMed Central. Prevalence of hypertrophic scar formation and its characteristics among the Chinese population That high proportion reflects the fact that hypertrophic scarring exists on a spectrum, and mild cases may not bother the patient at all. The color of hypertrophic scars was measurably different from surrounding skin in lightness, redness, and yellowness in that study.
Younger patients and those with darker skin tones are generally more prone to thickened scarring. The location of the incision also plays a role: areas under more mechanical tension during movement tend to produce wider scars, which is relevant for hip surgery since the thigh and hip flex constantly during walking.
On the rare and more serious end, skin necrosis can occur, where a patch of skin at the incision site dies due to inadequate blood supply. A case report described a 71-year-old patient who developed a large area of dead skin at the incision after an anterior-approach hip replacement, requiring surgical removal of the damaged tissue and reconstruction with a flap of tissue from the thigh. At one year, the reconstructed area looked satisfactory.9PubMed Central. Extensive skin necrosis following total hip arthroplasty performed through the direct anterior approach Cases like this are uncommon but illustrate why some hip replacement scars end up looking significantly different from the simple thin line most patients expect.
Managing and Improving the Scar After Surgery
For the first couple of weeks, wound care focuses on keeping the incision clean, dry, and protected. Your surgical team will give you specific instructions, but the basics involve gentle cleaning, keeping dressings in place, and watching for signs of infection like increasing redness, warmth, or discharge.
Negative pressure wound therapy, where a sealed dressing applies gentle suction to the incision, has been studied for hip arthroplasty wounds. A randomized study found that this approach decreased the development of fluid collections under the skin and improved wound healing in the early postoperative period.10PubMed Central. Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty However, a separate study noted that patients using these devices actually had more wound drainage at seven days, even though drainage lasting longer than two weeks was reduced.11PubMed. Incisional Negative Pressure Wound Therapy Devices Improve Short-Term Wound Complications, but Not Long-Term Infection Rate Following Hip and Knee Arthroplasty These devices are not standard for every patient but may be used for people at higher risk of wound problems.
Once the wound has closed and initial healing is underway, scar management products become an option. Silicone gel sheets are the best-studied over-the-counter treatment. A randomized trial found that silicone gel sheeting reduced the thickness, pain, itchiness, and firmness of hypertrophic scars over six months of use, with the moisturizing effect on the hard scar tissue likely contributing to the improvement.12Burns. A prospective randomized clinical trial to investigate the effect of silicone gel sheeting (Cica-Care) on post-traumatic hypertrophic scar among the Chinese population Topical preparations combining plant extracts with silicone have also shown promise in reducing scar vascularity, pigmentation, firmness, and height after joint replacement surgery compared to standard wound care.13The Open Medicinal Chemistry Journal. Phyto-Extracts and Silicone Gel (JUMI) in Reduction of Surgical Scar Post-joint Arthroplasty. A Randomized Control Trial
For scars that remain problematic despite conservative measures, more aggressive options include corticosteroid injections directly into the scar tissue. Injections of triamcinolone acetonide have been reported to improve hypertrophic scars in roughly 50 to 100 percent of cases, though recurrence rates range from about 9 to 50 percent depending on the study and scar type. Laser treatments can also be combined with corticosteroids; one trial found that fractional CO2 laser plus topical corticosteroid and corticosteroid injection alone both reduced scar scores, with the combination showing a lower recurrence rate at one year (about 9 percent versus 18 percent).14PubMed Central. The application of corticosteroids for pathological scar prevention and treatment: current review and update
How Patients Actually Feel About Their Scars
Given how much the surgical community discusses different approaches and techniques, you might expect patients to have strong feelings about their scars. The reality is more relaxed. A study comparing scar perception between patients who had the direct anterior approach and those who had the posterior approach found that 93 percent of anterior-approach patients and 91 percent of posterior-approach patients rated their overall scar appearance as “good,” with no significant difference between the two groups.15PubMed Central. Scar Perception After Two Surgical Approaches for Total Hip Arthroplasty
That is a striking finding. The anterior scar sits in a more hidden location and is often marketed as the more cosmetically friendly option, yet patients with the more visible posterior scar were essentially just as satisfied. Part of the explanation is context: people who need a hip replacement are typically dealing with significant pain and limited mobility. Once that pain is gone and they can walk freely again, a scar on the side of the hip feels like a small price. The scar’s location and length matter less to most patients than the fact that it healed without complications and does not hurt.
That said, some patients do care about the scar’s appearance, particularly younger patients, people whose work or hobbies involve exposing their legs, and those with a history of abnormal scarring. If scar cosmesis matters to you, it is worth discussing the approach and closure method with your surgeon beforehand. Just know that the functional outcome of the replacement and the likelihood of complications are far more important decision factors than where the line ends up.
Factors That Push Scars Toward Better or Worse
Several variables influence how your hip replacement scar ultimately looks, and most of them are not under the surgeon’s control:
- Age: Older skin tends to scar less aggressively because it produces less collagen. A 75-year-old’s scar may end up thinner and flatter than a 50-year-old’s, though older skin is also thinner and more fragile, which can lead to wider scars if the edges do not come together well.
- Skin tone: People with darker skin are more prone to hypertrophic and keloid scarring. The scar may also develop post-inflammatory hyperpigmentation, where the healed area remains darker than the surrounding skin for months or years.
- Body weight: Larger body habitus can put more tension on the wound during healing and may increase the risk of wound complications like seromas or infection, both of which worsen the final scar.
- Smoking: Tobacco use restricts blood flow to the skin, slowing healing and increasing the risk of wound breakdown. Surgeons routinely ask patients to stop smoking well before surgery.
- Diabetes and vascular disease: Any condition that impairs blood supply to the skin or delays healing can produce a worse scar.
- Medications: Blood thinners can cause more bruising around the incision, and long-term steroid use thins the skin, making it more vulnerable to tearing.
Sun exposure is another often-overlooked factor. A new scar exposed to UV light during the first year of healing is more likely to darken permanently. Covering the scar with clothing or applying sunscreen once the wound is fully closed can help prevent this.
What Revision Scars Look Like
If a hip replacement eventually needs to be redone, the revision surgery creates a new scar or reopens the old one. Surgeons prefer to cut through the existing scar tissue whenever anatomically feasible, which avoids adding a second parallel scar and reduces additional soft-tissue damage.1PubMed Central. Surgical approaches in revision arthroplasty However, revision procedures often require more extensive exposure than the original surgery, so the incision may be longer. The revision scar tends to be wider and more prominent than the original, partly because cutting through scar tissue disrupts the organized collagen that had formed, and partly because the surrounding tissue has already been operated on once.
In cases where the revision must use a different approach than the original surgery, a second scar in a different location is unavoidable. Some patients who have had multiple hip surgeries end up with two or three scars in different orientations around the joint. These are cosmetically less ideal but are usually necessary for the surgeon to safely access the joint and achieve a good functional result.