Hip Replacement

Hip Replacement without restrictions

Sparing Piriformis and Internus, Repair Externus

(S.P.A.I.R.E.) technique 

Muscle Sparing

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). 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.

Early mobilisation

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)

Research Guided

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).

Without Restrictions

No Restriction is required following S.P.A.I.R.E. Hip Replacement, the muscles at the back of the hips are preserved with this approach.  They act as checkreins to reduce the risk of dislocation after surgery.

Prof Paul Lee

Prof Paul Lee


With a PhD in Medical Engineering, Prof. Lee has a great understanding of Orthopaedic Implants. In order to provide the best possible solution to his patients, Prof Lee has personally reviewed, analysed and published the results of all hip implants he uses in clinical practice. 

Being a certified expert and faculty with the Exeter Hip System, Prof. Lee can offer a personalised implant to all of his patients. Using a proven technique ensures leg length, offset and versions are perfect every time. With impaction bone grafting techniques, Prof. Lee can offer a biological solution to patients and regenerate bone in complex cases. With the unique enhanced recovery programme and muscle sparing approach, hip replacement surgery is indeed a truly successful operation.

Prof. Lee is Fellowship trained in the S.P.A.I.R.E approach in total hip replacement with Prof A.J. Timperley.

S.P.A.I.R.E. has the benefit of avoiding cutting the abductor complex as well as preserving the quadriceps coxae. This muscle complex plays an essential role in single legged stand, rising from sitting and propulsive motions.

Muscle Sparing

No Restrictions

Early Recovery



  • Lee YC, Callary SA, Howie DW, Thewlis D, Solomon LB. (2012) 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.  (2014) 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. (2017) 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
  • Research Gate image click here

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