Rethinking Hip Surgery: A Systematic Review of Sparing Piriformis and Internus, Repairing Externus (SPAIRE) vs. Traditional Hemiarthroplasty Approaches

When elderly patients experience a displaced intracapsular hip fracture, hemiarthroplasty is still the go-to surgical treatment. More recently, a new approach called Sparing Piriformis and Internus, Repairing Externus (SPAIRE) has started gaining attention, in addition to the lateral and anterior approaches already being used. It's designed to lower the chances of dislocation and help patients recover better after surgery. This review looks at studies that have compared the SPAIRE technique with older, more established surgical methods, especially in terms of things like survival rates, where patients go after discharge, how much pain they feel after surgery, and any complications that come up, like hip dislocations and periprosthetic fractures. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included randomized controlled trials (RCTs), non-RCTs, and observational studies that compared outcomes between patients undergoing hemiarthroplasty using either the SPAIRE technique or conventional lateral/anterior approaches. The total number of hips included in our study was 1385. Outcomes assessed included mortality, discharge destination, postoperative mobility, pain scores, and bone mineral density. Comparative evidence suggests that the SPAIRE approach may offer certain short-term advantages over conventional hemiarthroplasty techniques, particularly in terms of early postoperative mobility and pain management. However, these benefits do not appear to translate into significant long-term differences in functional recovery or patient-reported outcomes. Similarly, discharge destinations and bone health indicators show no consistent variation between SPAIRE and other commonly employed surgical approaches. Overall, the available literature indicates that while SPAIRE may provide early postoperative benefits, its long-term outcomes are broadly comparable to alternative methods. To our knowledge, this is the first systematic review comparing the SPAIRE approach with established surgical techniques in hip hemiarthroplasty. While some outcomes suggest potential advantages with SPAIRE, the current evidence base is limited. Further high-quality, large-scale studies are required to determine its definitive clinical benefit over traditional approaches.