It is a question patients facing joint replacement surgery often ask. Worrying about scars is only natural, since a scar is something they can still see with their own eyes after surgery. But similar incision length and location do not mean every surgery is the same. We need to look deeper, at how the muscles and tendons were handled far beneath the skin.
The skin incision is the entrance to surgery
When renovating a house, using a door of the same size does not mean the work done inside is the same. A renovation that leaves important internal structures intact follows a different process from one that detaches part of the structure and then restores it. The entrance visible from the outside alone cannot reveal that difference.
A skin incision is likewise an entrance for reaching the joint. The hip lies deep beneath the skin, surrounded by muscles, tendons, and the joint capsule. Even if incisions look similar in length and location, which tissues were detached and which were preserved inside can differ. That is why the wound left on the skin alone cannot explain everything about a surgery.
It is your own body that moves the artificial joint
Hip replacement surgery replaces a damaged joint with a new one. But it is still the patient's own muscles and tendons that move and support the artificial joint. The tissues around the joint must do their job for movements such as standing up, walking, and changing direction to remain stable.
In surgery, therefore, careful handling of the surrounding tissues is just as important as implanting the artificial joint. The surgeon must secure the necessary space while minimizing unnecessary damage to muscles and tendons, protecting nerves and blood vessels, and properly restoring any tissue that has been detached. Preservation is not visible from the outside, but it is something to consider when thinking about recovery.
For example, the short external rotators at the back of the hip act as the "core of the hip," stabilizing movement close to the joint and supporting its posterior side. I place great importance on maintaining, to the extent possible, the original attachment of the major external rotator tendons to the bone. It is an effort to help the muscles retain their natural function and to protect the posterior stability of the hip, reducing the risk of dislocation.
When necessary, detaching a tendon and reattaching it is also an important method of restoration. However, a reattached site must go through a healing process, which is why there is value in assessing whether the original attachment can be safely maintained. The key is judging which parts to preserve and which to restore according to each patient's condition.
Similar incisions can still mean different surgeries
Even between two surgeries with similar skin incisions, one may detach and reattach a tendon while the other proceeds with the original attachment intact. The visible scar may look similar, but the way tissues were handled deep inside is different. Tendon-preserving surgery must be performed through a limited field of view, which can make it more demanding. The reason for accepting that difficulty lies not in the size of the skin wound but in protecting muscle function and joint stability.
Surgery that protects function deep inside
The purpose of tissue preservation is not simply to leave a record of a smaller incision. It is to ensure that the structures supporting the joint can continue to do their job after surgery. While the skin wound heals, the deep tissues go through their own recovery processes. Which tissues were preserved during surgery, and how they were restored, therefore becomes an important clue to understanding recovery.
Of course, the extent of preservation differs from patient to patient. When a joint is severely deformed or tissues have been altered by previous surgery, a wider field of view and additional procedures may be needed. What matters is the judgment to protect tissue that can be preserved, safely open what treatment requires, and carefully restore tissue that needs restoration.
A visible scar shows the entrance to surgery. But it cannot show which tissues were preserved beneath it or how they were restored. Similar skin incisions do not mean every surgery is the same. What also deserves attention in hip surgery is the attachment and function of the tissues left intact deep inside.
<Written by Song Sang-ho, Director of Wellton Hospital | Edited by Jang In-sun, Health Kyunghyang reporter>
Questions and answers
If skin incisions are similar in length and location, is it the same surgery?
No. A skin incision is only the entrance to the joint. Which tissues are detached deep beneath it, and which are preserved or restored, can differ from one surgery to another.
Why does preserving the short external rotators matter?
The short external rotators at the back of the hip act as the "core of the hip," stabilizing movement close to the joint and supporting its posterior side. Maintaining the original tendon attachment where possible helps preserve natural muscle function and posterior stability, reducing the risk of dislocation.
Can tissue be preserved in every patient?
The extent of preservation differs from patient to patient. A severely deformed joint or tissue altered by previous surgery may require a wider field of view and additional procedures. What matters is the judgment to protect what can be preserved, safely open what treatment requires, and carefully restore what needs restoration.
