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

Abstract

Background and purposeA tendon-sparing modification of the posterior approach to the hip joint was introduced in the specialist hip unit at our institution in 2016. The SPAIRE technique—acronym for “Saving Piriformis And Internus, Repair of Externus” preserves the insertions of gemellus inferior, obturator internus, gemellus superior and piriformis intact. We compare the results of the first 285 hip hemiarthroplasty patients, unselected but preferentially treated by our hip unit surgeons using the SPAIRE technique, with 567 patients treated by all orthopaedic surgeons (including the hip unit) in the department over the same 3.5 year period using the standard lateral approach. We report length of stay, return to pre-injury level of mobility, place of residence and mortality at 120 days.Patients and methodsThe review included all hemiarthroplasty patients. Pre-fracture mobility and place of residence, surgical approach, grade of senior surgeon in theatre, stem modularity, acute and overall length of stay, mobility, place of residence, re-operations and mortality at 120 days were recorded. Data were obtained from the National Hip Fracture Database that included a telephone follow-up at 120 days and from electronic patient records.ResultsThe odds of returning to pre-injury level of mobility were higher in the SPAIRE technique group than in the standard lateral group; adjusted odds ratio (95% confidence interval (CI)) 1.7 (1.1 to 2.7, p = 0.01).InterpretationWhen used in hip hemiarthroplasty, the SPAIRE technique appears safe and may confer benefit in maintaining the pre-injury level of mobility over the standard lateral approach.