The SPAIRE method

What Is the SPAIRE Hip Replacement Method?

A muscle-sparing approach to hip replacement used where clinically suitable. Here is what it means in patient language, who it tends to suit and what it does not promise.

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A woman running through wooded trails, picture of mobility.

SPAIRE is one tool in a hip surgeon's set. It is the one I am best known for, but it earns its place case by case, not as a marketing badge.

Professor Paul LeeConsultant Orthopaedic Surgeon

In plain English

A hip replacement that aims to leave certain muscles where it finds them.

The hip joint is stabilised by a group of small muscles and tendons at the back of the joint. In a traditional posterior hip replacement most of these are released to give the surgeon access, then reattached. The SPAIRE approach aims to keep the piriformis and obturator internus attached to the bone throughout.

Saved: preserved on the boneRepaired: released to access, restored at the end

The acronym, in plain English

Save Piriformis And Internus, Repair Externus.

Hover or tap any muscle on the diagram.

Piriformis

Saved

Left attached to the bone. A key stabiliser at the back of the hip; preserving it is designed to support a hip that feels secure earlier.

SPAIRE is one technique among several used in modern hip replacement. It is not a brand-new operation and it does not replace the surgeon's judgement about what is right for each individual hip.

Why preserving muscles may matter

The aim is a hip that feels stable sooner, without compromising the replacement itself.

Early stability

Preserving stabilising muscles is designed to support a hip that feels secure earlier in recovery for suitable patients.

Fewer routine precautions

In suitable patients, some of the strict early movement precautions used after traditional approaches may be relaxed. Your surgeon will confirm what applies to you.

Same well-tested implants

The implants, the bearing surfaces and the fundamental replacement are unchanged. The variable is the approach to the joint, not the joint itself.

Outcomes vary by patient. Individual recovery depends on your starting condition, your rehabilitation, and how your body heals.

Who may be suitable

SPAIRE may suit you if…

You are a candidate for hip replacement on standard clinical grounds.
Your imaging suggests the muscle-sparing approach can be performed safely on your anatomy.
You have not had previous hip replacement on the same side.
You are fit enough for general or regional anaesthesia.
You have realistic expectations about recovery.

Who may not be suitable

SPAIRE may not suit you if…

You are having revision hip surgery.
Your anatomy or prior surgery makes the approach less safe.
Intra-operative findings call for a different approach. The surgeon will always do what is safest for your joint.
You have specific medical conditions that influence the choice of approach.

If SPAIRE is not the right approach for you, Professor Lee will say so and explain what is.

Worth asking

Five questions you can ask any hip surgeon about SPAIRE.

1
How often do you perform SPAIRE in a typical month?
2
What criteria do you use to decide if SPAIRE is right for me?
3
What alternative approach would you use if SPAIRE is not suitable?
4
What does your own audit say about your outcomes?
5
What does my early recovery look like, week by week?
6
What are the specific risks you would highlight in my case?

Risks & limitations

SPAIRE does not change what surgery is.

SPAIRE is still hip replacement. It carries the same family of risks as other approaches: infection, blood clots, dislocation, leg-length difference, fracture, and rarely the need for revision. These are discussed in detail at consultation so that you can give properly informed consent.

SPAIRE does not guarantee a faster recovery, a painless recovery, or a particular long-term result. It is one tool that, used in the right patient by an experienced surgeon, may support good outcomes.

See the risks section on the private hip replacement page for a fuller list.

FAQs

Frequently asked questions

What does SPAIRE stand for?

SPAIRE refers to a posterior hip replacement technique that aims to spare the short external rotators and the piriformis tendon, which sit at the back of the hip and help stabilise the joint.

How is SPAIRE different from a traditional posterior approach?

In a traditional posterior approach those small muscles and tendons are released and repaired. SPAIRE aims to keep them attached to the bone, where possible.

Who may be suitable for SPAIRE?

Patients with hip arthritis who are otherwise candidates for hip replacement and whose anatomy and imaging suggest the muscle-sparing technique can be performed safely.

Who may not be suitable?

SPAIRE may not be suitable in revision surgery, in some patients with previous hip surgery, with certain anatomical variants, or where intra-operative findings call for a different approach. Professor Lee will discuss this honestly with you.

What should I ask my surgeon?

Ask how often they perform SPAIRE, what their criteria are for using it, what alternatives they would recommend if SPAIRE is not suitable, and what their personal audit data looks like.

How does SPAIRE affect recovery?

Preserving muscles and tendons is designed to support early mobility and reduce post-operative precautions for suitable patients. Individual recovery still varies and depends on the patient and the rehabilitation plan.

Find out if it suits you

Book a consultation with Professor Lee.

Suitability for SPAIRE is confirmed by examination and imaging, not by the website. Package from £13,500 for suitable patients, surgery on Harley Street, London.

Book a consultation Or book a discovery call first

Clinical lead: Professor Paul Lee, Consultant Orthopaedic Surgeon. Suitability is assessed during consultation; all surgery carries risks.

Clinically led by Professor Paul Lee · Consultant Orthopaedic Surgeon · GMC 6115197

Last reviewed: 7 June 2026