The STAR approach (Superior Transverse Anatomic Reconstruction) is an evolved posterior approach in total hip arthroplasty (THA) designed to optimize soft-tissue preservation and surgical exposure. In this interview with Antoine Piercecchi, Eleftherios Tsiridis details the rationale, kinematics, and surgical application of this technique.
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Incision & Anatomic Preservation
Placed higher and horizontally along Langer's lines (posterior bikini incision), the approach ensures minimal scar tension, high vascularity, and rapid wound healing. Its key anatomic benefit is complete piriformis preservation, maintaining joint stability alongside the gluteus medius and minimus.
Surgical Technique & exposure
- Vascular & nerve safety: Hemostasis is easily achieved by controlling a single vessel (branch of the lateral femoral circumflex artery), with zero reported nerve injuries.
- Exposure & compatibility: Provides direct visualization of both the acetabulum and femur, making it ideal for 3D CT-guided planning and spinopelvic alignment execution.
Primary vs. revision Application
While optimal for primary THA, the STAR approach can be extended to straightforward revisions. Mobilizing the femur by releasing part of the gluteus maximus tendon insertion allows anterior displacement without compromising the piriformis muscle.
Eleftherios Tsiridis (MD, MSc (Orth), DMed, PhD (London), FACS, FRCS) is Professor & Chairman of Orthropaedic Surgery, Director of Adult Joint Reconstruction and the Arthroplasty Registry (ART) at AUTH University of Thessaloniki in Greece, as well as President of the Hellenic Hip and Knee Society and President Elect of the European Hip Society (EHS) and Vice President of Hellenic Orthopaedic Association. He trained and worked in the UK and USA for 20 years developing international activity, profile and recognition through his clinical and research work comprising of 250 publications with 15,000 citations and an h factor of 52 along with 15 completed PhD theses and 3milion Euros in research grants.
He is a high volume Surgeon performing over 600 arthroplasty cases per year, including revisions and robotics. He is the innovator of VR technology in Orthopaedics, founder of the start-up Orama VR.SA and pioneer in robotic Surgery in Europe.
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