Journal of Orthopedic Surgery and Techniques J Orthop Surg Tech 2578-7187 Scholars Direct 561 Thomas L Berkley Way, Oakland, California 94612, USA Technical Tip: The Modified SPAIRE (Spare Piriformis and Internus, Repair Externus) Approach for Hip Arthroplasty Surgery Selvaratnam V 10.36959/453/601 In 2016, the Exeter Hip Unit, United Kingdom popularized the SPAIRE (Spare Piriformis and Internus, Repair Externus) approach for hip arthroplasty procedures [1]. This is a tendon sparing posterior approach to the hip which only involves division of the obturator externus tendon and part of the quadratus femoris muscle from their femoral insertions. The tendon insertions of piriformis, superior gemellus, obturator internus and inferior gemellus are spared [1]. Image Article 6 1 OPEN ACCESS Technical Tip: The Modified SPAIRE (Spare Piriformis and Internus, Repair Externus) Approach for Hip Arthroplasty Surgery Veenesh Selvaratnam National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Malaysia Izyan Irdina Ministry of Health, Malaysia Shalina Gunainthran Ministry of Health, Malaysia Veenesh Selvaratnam
National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
05 March 2023 Selvaratnam V, Irdina I, Gunainthran S 2023 Technical Tip: The Modified SPAIRE (Spare Piriformis and Internus, Repair Externus) Approach for Hip Arthroplasty Surgery J Orthop Surg Tech 2023 Selvaratnam V, et al © This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

In 2016, the Exeter Hip Unit, United Kingdom popularized the SPAIRE (Spare Piriformis and Internus, Repair Externus) approach for hip arthroplasty procedures [1]. This is a tendon sparing posterior approach to the hip which only involves division of the obturator externus tendon and part of the quadratus femoris muscle from their femoral insertions. The tendon insertions of piriformis, superior gemellus, obturator internus and inferior gemellus are spared [1].

The inferior gemellus is a muscular structure rather than tendinous unlike the obturator internus. It therefore almost always tears due to retraction to expose the hip joint when performing the SPAIRE approach. Therefore, we propose a Modified SPAIRE technique. In the modified SPAIRE technique the inferior gemellus is divided together with the obturator externus and part of the quadratus femoris at the femoral insertion when performing this approach (Figure 1). By dividing the inferior gemellus, it provides a better exposure and also preserves the inferior gemellus from getting damaged due to retraction. At the end of the procedure, inferior gemellus along with obturator externus and posterior capsule can be repaired with strong non-absorbable sutures through an enhanced trans-osseous technique onto the posterior aspect of the greater trochanter.

References Hanly RJ, Sokolowski S, Timperley AJ (2017) The spaire technique allows sparing of the piriformis and obturator internus in a modified posterior approach to the hip. Hip Int 27: 205-209. https://pubmed.ncbi.nlm.nih.gov/28218374/