The SPAIRE technique (Spare Piriformis And Internus, Repair Externus) involves a muscle sparing mini-posterior approach to the hip. Evidence will be prevented that the principle function of the “short external rotator” muscle group is primarily as an abductor and extensor of the flexed hip and has a profound influenced on weight bearing rising and propulsive motions; also that details of the insertions of the piriformis tendon and conjoint insertion of obturator internus and the gemelli (the Quadriceps Coxa) have previously been poorly appreciated. We have developed a surgical technique (SPAIRE) during which the only tendon released, and subsequently repaired, is obturator externus. The author has carried out the SPAIRE technique for all routine hip arthroplasties for the last 18 months. This cohort has been compared with a matched control group for a comprehensive array of outcome measures. Results show no disadvantage of using the technique. On-table stability is so impressive that when the SPAIRE technique has been used no postoperative restrictions whatsoever are placed on the patient who is immediately encouraged to exercise the hip through a full excursion of movement. Fewer tendons are damaged using the SPAIRE technique than any other approach to the hip including Direct Anterior and Direct Superior approaches. Randomised prospective studies are on-going using objective measurements of Gait and muscle power as well as functional and patient reported outcomes to prove benefit of the SPAIRE technique. For hemiarthroplasty cases a separate RCT is being undertaken comparing the SPAIRE technique with a direct lateral approach. It is believed that this technique may become the default technique for hemi- and total- hip arthroplasty through a posterior approach and for all hip fracture arthroplasty cases.
Post-operative gait abnormalities are recognized following total hip arthroplasty (THA). Despite global improvement in functional outcome, gait abnormality persists for a decade or more. In this study 3-dimensional gait analysis (3DGA) was performed using a portable system with Inertial Measurement Units (IMUs) to quantify this abnormality. The gait of 55 patients with monarthrodial hip arthrosis was measured pre-operatively and at one year post-surgery. Patients with medical co-morbidity or other conditions affecting their gait were excluded. Six IMUs were aligned at the level of the anterior superior iliac spines, mid-thigh and mid-leg. Data was analysed using proprietary software. Each patient underwent a conventional THA using a posterolateral approach. 92 healthy individuals were assessed for comparison.Introduction
Methods
