STAR: piriformis preserving posterior approach – the new paradigm
Background / Problem Total hip arthroplasty (THA) approaches seek to balance minimal soft tissue disruption with adequate surgical exposure and component positioning accuracy. While the standard posterior approach offers excellent visualization, it typically involves releasing the piriformis tendon, which can compromise postoperative hip stability.
Objective of the Article This article describes the Superior Transverse Anatomic Reconstruction (STAR) approach, a piriformis-preserving, mini-posterior technique for THA. It outlines the surgical steps, underlying rationale, and summarizes the current clinical evidence supporting its use in modern arthroplasty.
Key Points / Core Message The STAR approach utilizes a short transverse incision and a gluteus maximus split, meticulously preserving the piriformis muscle while releasing and subsequently repairing the other short external rotators. This technique provides unobstructed 360° ("full moon") visualization of the acetabulum and direct access to the proximal femur, facilitating accurate implant placement without specialized instrumentation or a traction table. Its versatility extends from routine primary cases to complex dysplasia and select revisions. Prospective comparative studies demonstrate that, compared to direct superior and standard posterior approaches, the STAR technique is associated with reduced blood loss, shorter hospital stays, and faster early functional recovery. Notably, surgeons transitioning from a standard posterior approach have shown no significant learning curve.
Conclusion / Implications for Practice The STAR approach is a safe, effective, and reproducible muscle-sparing technique for THA. By preserving the piriformis tendon, it enhances hip stability while maintaining the exposure benefits of a posterior-based approach. The growing body of clinical evidence supports its role in promoting rapid recovery and achieving excellent outcomes, making it a valuable technique for hip arthroplasty surgeons.
