STAR Hip Replacement Procedure: Q&A With an Orthopaedic Surgeon
Johns Hopkins is a leader in superior transverse atraumatic reconstruction, or STAR.
Featured Expert
May 18, 2026
Johns Hopkins is one of just a few locations nationwide offering a hip replacement technique that promises less trauma and faster recovery compared to traditional approaches.
“It is less painful, and it’s a faster recovery,” says Savya Thakkar, M.D., hip and knee reconstructive surgeon at Johns Hopkins, and a leader in both performing the surgery and in educating other surgeons at Johns Hopkins and elsewhere in the technique.
Key Points
- The STAR hip replacement technique promises faster recovery compared to other hip replacement approaches.
- People can typically walk the same day, and many do not need an overnight hospital stay.
- STAR spares the piriformis muscle and tendons and reduces soft tissue trauma.
- It is available at only a few hospitals nationwide, including Johns Hopkins.
What is superior transverse atraumatic reconstruction (STAR)?
The superior transverse atraumatic reconstruction (STAR) approach is a minimally invasive hip replacement procedure that does not cut or otherwise damage the piriformis muscle or iliotibial band.
The STAR acronym refers mainly to how the surgeon accesses the hip joint, which is above (superior to) the vastus ridge, a bony prominence at the top of the thigh, and crosses (transverses) at a 45-degree angle. Atraumatic refers to the fact that no muscles are cut or damaged during the procedure, and reconstruction refers to repairing the incision after the hip implant is inserted.
How is STAR different from other hip replacement approaches?
STAR is less invasive, with less trauma or risk of infection than most other hip replacement approaches.
The STAR technique was created as an improvement to the direct superior approach (DSA), a minimally invasive method of accessing the hip through the top. The DSA avoids cutting the iliotibial band and certain external rotators. However, unlike the STAR approach, the direct superior approach does not protect or preserve the piriformis muscle or conjoint tendon.
Another common hip replacement option is the anterior approach, which became popular in recent years because it involves a small incision in the front of the hip, instead of going through the gluteus maximus, the largest buttock muscle. Though the anterior approach is muscle-sparing, it typically relies on an X-ray and specialized equipment so that surgeons can work between muscles, and it has a slightly higher risk of infection because the incision goes through the groin, says Thakkar.
The STAR approach does not have those drawbacks. It protects the piriformis and other short external rotators, does not go through the groin, and does not require use of an X-ray.
| Key Factors | STAR Approach | Direct Superior Approach (DSA) | Anterior Approach |
|---|---|---|---|
| Where the incision is made | Back top of the hip, similar area to DSA but smaller | Back top side of the hip, near the upper buttock | Front of the upper thigh, near the hip crease |
| Use of imaging | Not necessary | Not necessary | Preferred (live X-ray) |
| Gluteus maximus and other muscles | Gluteus maximus is split along fibers. Deeper muscles are minimally involved. | Gluteus maximus is split along fibers. Deeper muscles may be involved. | Gluteus maximus is not involved. Other muscles may be moved aside and placed back. |
| Tendons detached | No tendons are detached. | Some tendons may be detached and repaired at the end. | No tendons are detached. |
| Hip capsule (joint envelope) | Partially opened and repaired | Partially opened and repaired | Fully opened and may be repaired |
| Hip dislocation during surgery | Fully dislocated | Partially dislocated | Fully dislocated |
| Level of invasiveness | Very low (muscle and tendon-sparing) | Low (muscle-sparing) | Very low (muscle-sparing) |
| Mobility after the surgery | Often walking same day | Often walking same day or next day | Often walking same day |
| Procedure availability | Limited availability | Increasingly common | Widely available |
What is recovery like after STAR hip replacement?
Recovery after STAR is extremely quick. Patients are up and walking the same day and can often go home without an overnight hospital stay.
“It removes the need for any muscle dissection or muscle disturbance,” says Thakkar. “It's a faster recovery. It is less painful, and it involves really no precautions to the hip joint after surgery, as long as patients don’t have a fall.”
Learn more about hip replacement recovery.
Who can benefit from the STAR approach?
The STAR approach is appropriate for almost anyone who is a candidate for hip replacement, regardless of age and the type of hip problems. However, people who had a hip replacement that needed a correction surgery due to a failed implant or those who have fractures around the implant may not be candidates for STAR. Addressing these complications may require larger incisions.
Are there risks associated with STAR?
STAR shares many risks associated with other hip replacement procedures, including reactions to anesthesia and infection at the incision site. However, studies show that patients who have the STAR procedure have overall less risk. They experience less blood loss than with other hip replacement techniques and have minimal risk of nerve injury.
Can patients get the STAR procedure at Johns Hopkins Medicine?
Yes, STAR is available at Johns Hopkins through the Department of Orthopaedic Surgery’s joint replacement program.
In the U.S., just a handful of medical centers offer it so far, and Johns Hopkins is the only one in Maryland or its surrounding states, says Thakkar.
What sets Johns Hopkins apart in its STAR expertise?
At Johns Hopkins, STAR is performed by fellowship-trained orthopaedic surgeons. To date, the Hopkins team has performed more than 400 surgeries since adopting the STAR approach approximately one year ago.
“Our patients come to us with the expectation that if they're coming to Hopkins, they should get the latest and the greatest, but also the safest, and things that give them as seamless a recovery as possible,” says Thakkar.
Medically reviewed by Savya Thakkar, M.D.
