SPAIRE Approach Versus Direct Anterior Approach in Hemiarthroplasty for Displaced Femoral Neck Fractures: A Randomized Controlled Trial

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• Picked for Orthopedics and Sports Medicine (top studies of the week, 11 October 2026): SPAIRE vs direct anterior approach in hemiarthroplasty for femoral neck

Abstract

BACKGROUND: Several surgical approaches are used for hemiarthroplasty (HA) in femoral neck fractures (FNF). The Sparing Piriformis and Obturator Internus, Repair Externus (SPAIRE) approach, introduced in the Norwegian Hip Fracture Register in 2019, is gaining popularity, accounting for 18% of HAs in Norway in 2024. However, supporting evidence remains limited. This randomized controlled trial (RCT) aimed at comparing the SPAIRE and direct anterior (DA) approaches in patients with FNF treated with HA. METHODS: 158 patients with a displaced FNF operated with HA were from January 2022 to June 2024 included in this RCT at Sorlandet Hospital Kristiansand and Sorlandet Hospital Arendal and randomized to the SPAIRE (n = 79) or the DA approach (n = 79) and followed for 12 months. The mean age was 79 years (70-90), and 59% were women. Physiotherapists blinded to allocation collected functional outcomes and patient-reported outcome measures postoperatively and at 3 and 12 months. RESULTS: 158 patients were included and 126 were assessed at final follow-up. All patients received the allocated treatment, and the randomization groups were similar. The duration of surgery was 52 min in the SPAIRE group vs. 63 minutes in the DA group (mean difference 9 minutes, 95% confidence interval [CI] 8-15; p < 0.01). At 12 months, the mean Harris Hip Score was 86 and 88, respectively (mean difference 2.3, 95% CI -2.7 to 7.3; p = 0.365). We did not find clinically relevant differences in patient-reported outcome measures between the groups at any time point. Nine complications requiring reoperation were recorded in 8 patients. CONCLUSION: No significant differences in clinical outcomes were found between patients operated with the DA or SPAIRE approach. SPAIRE approach may be an alternative for posterior approach surgeons performing HA on FNF patients. However, larger studies are warranted to establish the clinical implications of the approach. LEVEL OF EVIDENCE: Level II. See Instructions for Authors for a complete description of levels of evidence.

Abstract as published, via PubMed.