Transition from the posterior to the Superior Transverse Anatomic Reconstruction (STAR) approach for total hip arthroplasty

Aims The Superior Transverse Anatomic Reconstruction (STAR) approach for total hip arthroplasty (THA) is a modified posterior approach that preserves the piriformis and the quadratus femoris. This approach provides improved short-term outcomes, but few studies compare patients undergoing THA with STAR to the posterolateral approach (PA). The goal of this study is to compare the short-term perioperative outcomes of STAR with PA and evaluate the learning curve associated with the STAR approach. Methods A total of 561 consecutive patients who underwent primary THA from 1 August 2023 to 30 April 2024 were included in the STAR approach cohort. Patients in the PA cohort underwent primary THA from 1 January 2017 to 31 July 2023 and were matched 1:1 with STAR patients by age, sex, BMI, and surgeon. Continuous outcomes (change in Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR), estimated blood loss (EBL), length of stay (LOS), operating time, opioid use, morphine milligram equivalents, and binary outcomes (transfusion, readmission, complications) were assessed with multiple linear regression at six weeks post operation. Results STAR cohort patients used less postoperative opiods in the immediate postoperative period and at six weeks (MME 65 (SD 58) vs 107 (SD 126); p < 0.001, and 258 (SD 273) vs 364 (SD 308); p < 0.001, respectively) and experienced less EBL (127 ml (SD 55) vs 162 ml (SD 87); p < 0.001), lower operating time (82 minutes (SD 24) vs 90 minutes (SD 27); p < 0.001), and shorter LOS (0.9 days (SD 1.2) vs 1.7 days (SD 1.3); p < 0.001). There were no differences in the change in HOOS, JR score from pre- to postoperative, the rate of blood transfusion, readmission, or postoperative complications requiring revision. Conclusion The STAR approach is a piriformis and quadratus preserving approach that can be used for primary THA and without a learning curve. The benefits of the STAR approach may include a shorter operating time, less EBL, shorter LOS, and less postoperative pain requiring opioids. Longer-term follow-up in necessary to determine if the STAR approach continues to be associated with a lower overall revision rate compared with the conventional posterior approach. Cite this article: Bone Jt Open 2026;7(3):303–308.