Preserving  the quadriceps coxae with the S.P.A.I.R.E. technique, MSK Doctors believes will give the best chance for patients to recover without restrictions.

Phone : 02032398823

Email : [email protected]kdoctors.com

Surgeon:  Professor Paul Y F Lee - experience 


A modification of the posterior approach in total hip replacement, S.P.A.I.R.E. has the benefit of avoiding cutting the abductor complex as well as preserving both gemelli, obturator internus and piriformis tendons (quadriceps coxae). This technique has been described as S.P.A.I.R.E. (Sparing Piriformis And Internus, Repair Externus), which will offer the functional benefits of the posterior approach to facilitate early mobilisation with reduced risk of dislocation (Hanly et al 2017). During his fellowship training in the world renowned Exeter Hip Unit, Prof. Lee has perfected the S.P.A.I.R.E technique under the mentorship of Professor Timperley.  After reviewing the results and publishing the advantages of this technique in medical journals, S.P.A.I.R.E. has become Prof. Lee’s routine practice for total hip replacement.

Surgical technique publication 2017: Details of a Tendon–Sparing Posterior Approach (S.P.A.I.R.E) by Prof. Lee click here

Research has shown that the quadriceps coxae is not just an external rotator and is the primary abductor and extensor for the hip joint in a 90° flexed position, which means it has a major effect on one-legged and weight-bearing rising and propulsive motions. These muscles are essential every time a patient tries to get up from a chair (Lee et al 2012).




  • Lee YC, Callary SA, Howie DW, Thewlis D, Solomon LB. The Effect of Hip Position on the Length of Trochanteric Muscles: Potential Implications for Early Postoperative Management of Hip Arthroplasty. The Journal of Arthroplasty. 2012 6//;27(6):953-60.e2
  • Vaarbakken K, Steen H, Samuelsen G, Dahl HA, Leergaard TB, Nordsletten L, et al. Lengths of the external hip rotators in mobilized cadavers indicate the quadriceps coxa as a primary abductor and extensor of the flexed hip. Clin Biomech (Bristol, Avon). 2014 Aug;29(7):794-802.
  • Hanly RJ, Sokolowski S, Timperley AJ. The SPAIRE technique allows sparing of the piriformis and obturator internus in a modified posterior approach to the hip. Hip Int. [10.5301/hipint.5000490]. 2017 Feb 08:0.  
  • Lee PYF, Charity J, Timperley J (2017) Details of a Tendon–Sparing Posterior Approach in Hemiarthroplasty in the Treatment of Displaced Intracapsular Neck of Femur Fracture. J Arthritis 6: 243. doi:10.4172/2167-7921.1000243                

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Email : [email protected]

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