Log in

The SPAIRE Approach for Hip Arthroplasty: Short-Term Functional Outcome in an Indian Scenario

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Introduction

Hip arthroplasty, including hemiarthroplasty and total hip arthroplasty is a common surgical procedure for patients suffering from hip joint disorders with an aim of complication free early return to activities of daily living. Various minimally invasive surgical approaches have been described to achieve this aim including a relatively new SPAIRE approach. This case series shows our technique of hip arthroplasty using the SPAIRE technique with the help of conventional instruments in an Indian Scenario at a tertiary care center in Eastern India along with our short-term functional outcomes till a follow up period of 6 months.

Materials and method

This was the prospective observational study done between May 2022 to Oct 2023 in Tata Main hospital, Jamshedpur. Total 35 patients were operated by this technique. Data including age, gender, time to return orthotic assisted mobility, Harris hip score at 2 months & any complications till the follow up of 6 months were recorded for each patient who underwent Hemiarthroplasty or Total Hip arthroplasty using the SPAIRE technique with conventional instruments for hip arthroplasty (performed by single surgeon – the senior author) in our tertiary care center.

Results

35 patients were operated during this span by using the SPAIRE technique. There were 30 cases of hip hemiarthroplasty and 5 cases of total hip arthroplasty (1 bilateral). 5 patients were lost to follow up during the period of 6 months. Harris hip score was measured for each patient at 2 months and mean Harris hip score was 83.16. Out of 35 patients, 9 patients had excellent outcome, 14 patients had good outcome and 7 patients had fair outcome. No patient had complications such as infection, delayed wound healing, periprosthetic fractures or sciatic nerve injury. One patient reported dislocation at 3 months following a fall. Mean time to return to orthotic assisted ambulation was 1.5 days for all 35 patients.

Conclusion

SPAIRE technique is one of the safe surgical approaches for primary hip arthroplasties. This minimally invasive tendon sparing approach which preserves quadricep coxa provides excellent hip stability, early return to preinjury activities. It also reduces postoperative complications such as dislocation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Schleicher, I., Haas, H., Adams, T. S., Szalay, G., Klein, H., & Kordelle, J. (2011). Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach. Acta Orthopædica Belgica, 77(4), 480.

    PubMed  Google Scholar 

  2. Mulliken, B. D., Rorabeck, C. H., Bourne, R. B., & Nayak, N. (1995). The surgical approach to total hip arthroplasty: Complications and utility of a modified direct lateral approach. Iowa Orthopeadic Journal, 15, 48.

    CAS  Google Scholar 

  3. Hanly, R. J., Sokolowski, S., & Timperley, A. J. (2017). He SPAIRE technique allows sparing of the piriformis and obturator internus in a modified posterior approach to the hip. Hip International, 27, 205–209.

    Article  PubMed  Google Scholar 

  4. Kristensen, T. B., Vinje, T., Havelin, L. I., Engesaeter, L. B., & Gjertsen, J. E. (2017). Posterior approach compared to direct lateral approach resulted in better patient-reported outcome aier hemiarthroplasty for femoral neck fracture. Acta Orthopaedica, 88, 29–34.

    Article  PubMed  Google Scholar 

  5. Leonardsson, O., Rolfson, O., & Rogmark, C. (2016). He surgical approach for hemiarthroplasty does not influence patient-reported outcome: a national survey of 2118 patients with one-year follow-upa. The Bone & Joint Journal, 98-B(4), 542–547.

    Article  CAS  Google Scholar 

  6. Hardinge, K. (1982). He direct lateral approach to the hip. The Journal of Bone and Joint Surgery. British Volume, 64, 17–19.

    CAS  PubMed  Google Scholar 

  7. Moore, A. T. (1957). He self-locking metal hip prosthesis. Journal of Bone and Joint Surgery. American Volume, 39-A(4), 811–827.

    CAS  PubMed  Google Scholar 

  8. Harris, W. H. (1969). Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty: An end-result study using a new method of result evaluation. The Journal of Bone & Joint Surgery, 51(4), 737–755.

    Article  CAS  Google Scholar 

  9. Vaarbakken, K., Steen, H., Samuelsen, G., et al. (2014). Lengths of the external hip rotators in mobilized cadavers indicate the quadriceps coxa as a primary abductor and extensor of the flexed hip. Clinical Biomechanics (Bristol, Avon), 29(7), 794–802.

    Article  PubMed  Google Scholar 

  10. Vaarbakken, K., Steen, H., Samuelsen, G., Dahl, H. A., Leergaard, T. B., & Stuge, B. (2015). Primary functions of the quadratus femoris and obturator externus muscles indicated from lengths and moment arms measured in mobilized cadavers. Clinical Biomechanics (Bristol, Avon), 30(3), 231–237.

    Article  PubMed  Google Scholar 

  11. Kim, Y. S., Kwon, S. Y., Sun, D. H., Han, S. K., & Maloney, W. J. (2008). Modified posterior approach to total hip arthroplasty to enhance joint stability. Clinical Orthopaedics & Related Research, 466, 294–299.

    Article  Google Scholar 

  12. Solomon, L. B., Lee, Y. C., Callary, S. A., Beck, M., & Howie, D. W. (2010). Anatomy of piriformis, obturator internus and obturator externus: Implications for the posterior surgical approach to the hip. Journal of Bone & Joint Surgery. British Volume, 92(9), 1317–1324.

    CAS  Google Scholar 

  13. Philippon, M. J., Michalski, M. P., Campbell, K. J., et al. (2014). Surgically relevant bony and soft tissue anatomy of the proximal femur. Orthopaedic Journal Of Sports Medicine, 2(6), 2325967114535188.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ito, Y., Matsushita, I., Watanabe, H., & Kimura, T. (2012). Anatomic map** of short external rotators shows the limit of their preservation during total hip arthroplasty. Clinical Orthopaedics and Related Research, 470(6), 1690–1695.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pine, J., Binns, M., Wright, P., & Soames, R. (2011). Piriformis and obturator internus morphology: A cadaveric study. Clinical Anatomy, 24(1), 70–76.

    Article  PubMed  Google Scholar 

  16. Su, E. P., Mahoney, C. R., Adler, R. S., Padgett, D. E., & Pellicci, P. M. (2006). Integrity of repaired posterior structures after THA. Clinical Orthopaedics and Related Research, 447(447), 43–47.

    Article  PubMed  Google Scholar 

  17. Charity, J., Ball, S., & Timperley, A. J. (2023). The use of a modified posterior approach (SPAIRE) may be associated with an increase in return to pre-injury level of mobility compared to a standard lateral approach in hemiarthroplasty for displaced intracapsular hip fractures: a single-centre study of the first 285 cases over a period of 3.5 years. European Journal of Trauma and Emergency Surgery., 49(1), 155–163.

    Article  PubMed  Google Scholar 

  18. Price, A., Ball, S., Rhodes, S., Wickins, R., Gordon, E., Aylward, A., Cockcroft, E., Morgan-Trimmer, S., Powell, R., Timperley, J., & Charity, J. (2021). Effects of a modified muscle sparing posterior technique in hip hemiarthroplasty for displaced intracapsular fractures on postoperative function compared to a standard lateral approach (HemiSPAIRE): Protocol for a randomised controlled trial. British Medical Journal Open, 11(6), e045652.

    Google Scholar 

  19. Lee, P. Y., Charity, J., & Timperley, J. (2017). Details of a tendon-sparing posterior approach in hemiarthroplasty in the treatment of displaced intracapsular neck of femur fracture. Journal of Arthritis. https://doi.org/10.4172/2167-7921.1000243

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Akash Nagnath Mane.

Ethics declarations

Conflict of Interest

All authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Consent to Participate

Written informed consent was obtained from all patients. All participants provided informed consent to participate in this study.

Informed Consent

Informed consent taken from each participating patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, J., Mane, A.N., Niraj, N.K. et al. The SPAIRE Approach for Hip Arthroplasty: Short-Term Functional Outcome in an Indian Scenario. JOIO (2024). https://doi.org/10.1007/s43465-024-01215-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s43465-024-01215-2

Keywords

Navigation